As a runner you know the importance of keeping your feet in top condition. You may be well aware of the most common cause of runner's foot pain, namely heel pain or plantar fasciitis. But another condition nearly as prevalent as heel pain in runners is Achilles tendon pain.
And this shouldn't be surprising. After all the term "Achilles heel" comes from the Greek tragedy, the Illiad. In this saga, Achilles leads the Greeks against the Trojans. A powerful warrior his only weakness is his Achilles. For today's runner this is also true. An Achilles rupture or tear can be a season ending event.
While an Achilles rupture can change the outcome of a game or race, it's by no means the most common form of Achilles tendon pain. Achilles tendonitis and it's cousin Achilles tendonosis are much more common.
What is the Achilles tendon?
The Achilles is the largest and strongest tendon in the body. It can withstand forces of up to 1000 pounds or more. It's located where the calf muscle joins the heel bone. The Achilles makes it possible for us to push off while we run, jump, or walk. Without it we would be incapable of movement. That's why when our Achilles tendon becomes inflamed or sustains an injury treatment is imperative.
Achilles tendonitis is an inflammation of the Achilles tendon. It results from micro-tears that develop as a result of too heavy or sudden pressure on the tendon. These can occur as a result of running hills, rapidly increasing training time and distance, and sprinting.
Other risk factors
Other risk factors for Achilles tendonitis are:
- Sex (men are more prone to it)
- Increased age
- Over pronation resulting from flat or low arches
- Tight calf muscles
- Wearing unsupportive or worn out running shoes
- Medical conditions such as psoriasis and high blood pressure
- Taking antibiotics called fluoroquinolones.
Sign and Symptoms
- Mild pain after running that gradually worsens.
- Pain occurs most often after periods of rest and with first steps out of bed in the morning.
- A dull or sharp pain along back of tendon.
- Tenderness or sometimes intense pain can be experienced when the sides of the tendon are squeezed.
If you're experiencing any of the signs and symptoms of Achilles tendon pain it's important to stop running. Running through your pain will make the condition worse. Rest and sometimes immobilization in a walking boot are necessary to recover from Achilles tendonitis.
In addition, treatment at home or at your podiatry office often includes the following:
Reduce the inflammation
To assist in your recovery it's important to reduce the inflammation.
- Use ice 20 minutes out of every hour.
- Take nonsteroidal anti-inflammatory medication. Note: Consult your physician before taking any medication.
- Receive MLS laser therapy for pain relief and reduction of inflammation
Improve your foot biomechanics
- Orthotics can help support the muscle and relieve stress on the tendon. Over-the-counter shoe inserts or custom orthotics will both work depending on your foot type and the length and severity of the problem.
Stretch your calf muscles
Adequately stretching tight calf muscles is needed in the treatment and prevention of Achilles tendonitis. One of the best ways to do this is by using an Achilles splint 1-2 times/day for 20-30 minutes while watching TV or reading a book. Please watch this video on How to Use An Achilles Splint for Stretching Calf Muscles. Sports medicine physicians and others also recommend using a foam roller as an adjunct to stretching.
Get physical therapy
We recommend physical therapy for:
- exercises to lengthen the Achilles tendon
- strengthen the Achilles tendon
- gait training
Surgery may be needed if the tendon does not recover using more conservative approaches.
It's far better to prevent Achilles tendonitis than to heal from it.
- Increase your distance and running intensity slowly.
- Introduce changes to your running routine gradually.
- Always do a warm up and cool down (we recommend Dynamic warm-ups for runners)
- Purchase running shoes to suit your foot type and running style
- Do weekly strength training.
- Participate in other forms of exercise in addition to running such as yoga, weightlifting, and swimming.
Achilles tendonitis can progress to Achilles tendonosis if treatment of the former condition is not adequate. When the tendon heals it's more prone to reinjury because it has not been fully restored. When the disorder progresses to degeneration, it can become enlarged and nodules can develop in the area where the tissue is damaged.
Runners with Achilles tendonosis will experience pain, tenderness, and stiffness without inflammation (swelling and redness) seen in Achilles tendonitis.
Treatment and prevention include:
- Stopping running activities as these put stress on the tendon.
- Regenerative medicine such as MLS laser therapy or PRP or Platelet-Rich Plasma.
- Ice is of little value in treatment of this condition since there is usually no inflammation in this condition.
Achilles Tendon Rupture
An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Sudden accelerations during running or a trip or fall can overstretch the tendon and cause a tear.
Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.
Signs and Symptoms
While sometimes there are no signs and symptoms of Achilles tendon rupture the most common ones are:
- Feeling of being kicked or stabbed in the calf or ankle
- Popping or snapping sensation
- Swelling in the back of the leg between the heel and calf
- Difficulty walking and rising up on the toes
Men are at greater risk for Achilles tendon rupture due to their lack of flexibility compared to women. Runners with a previous history of Achilles tendonosis are also at greater risk.
Most often Achilles tendon ruptures require surgery since the chance of re-rupture is great for those still planning to continue with their running career. For those who plan a more sedentary lifestyle or concerns about nerve damage or infection should choose a more conservative treatment route similar to those used to treat the other two Achilles tendon conditions.
In addition to following all the previous recommendations stated earlier, runners who've a history of Achilles tendonosis should take great care to moderate their level of activity and watch out for irregularities in their running surface.
Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.
Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.