By Lori S. Weisenfeld, DPM, Sports Podiatrist
One of the more common and often mistreated overuse injuries that I see in my practice is Achilles tendinitis. This post will help runners understand this common injury. I’ll tell you how important it is to treat Achilles tendinitis correctly, and give you some tips for preventing it in the future.
What is Achilles tendinitis?
The Achilles tendon is the cable-like structure that you can feel behind your ankle. It attaches the calf muscles to your heel bone, and is the strongest tendon in the body. When the Achilles gets inflamed it’s called Achilles tendinitis.
What causes Achilles tendinitis?
Common causes of Achilles tendinitis amongst runners is an overly enthusiastic approach to hill work, speed work, and ramping up your mileage too quickly. Of course, I can say this for about 90% of running injuries. The key is to approach your training as you would weightlifting – in a gradual manner. Other common triggers for Achilles tendinitis are switching from a traditional running shoe to a lightweight (minimalist) shoe too quickly (the latter has a lower heel) and having tight calves.
When you have Achilles tendinitis, you might feel tightness behind the ankle or you can feel flat-out pain while walking. In the early stages, symptoms may be present only when you wake up in the morning or at the start of your run, and then the sensation can ease after a few minutes. As symptoms progress, the sore, tight feeling may last longer into the run or be present later in the day or the morning after you run.
What not to do when your Achilles is bothering you.
What makes Achilles tendinitis frustrating for me is that most patients self-treat it incorrectly before coming in to see me. It’s our natural inclination to stretch something that’s sore, so most people go ahead and increase stretching the Achilles when they feel symptoms there.
This is a no-no and may actually be counter-productive. The tendon is inflamed and you don’t want to cause more inflammation by yanking on the fibers. When you have this type of injury, you should rest the tendon and avoid placing more strain on the fibers. You will have plenty of time to stretch after you recover.
I usually advise my patients to place heel lifts in all of their shoe. This relaxes the tendon and takes the tension off of the Achilles. I don’t recommend the gel cushions because your heels actually sink into those. Firm foam or cork-type lifts are a better choice. Avoid very flat shoes, even while at home.
Ice or heat?
And if you were wondering which option to choose, ice rather than heat is in order for an acute inflammation. Icing should be performed for 10-20 minutes several times a day. If there is a bump in the tendon or the tendon feels swollen, then you should check in with your podiatrist to make sure that you don’t have a small tear within the tendon itself. Also, if symptoms don’t go away with these simple measures, then seeing your podiatrist, orthopedist or sports doctor is a must.
Important things to know about stretching as a therapy.
One note on stretching to prevent Achilles injuries and to rehab the area afterwards: tendons don’t have a lot of flexibility, muscles do. Your time will be better spent, more effective and safer if you focus your stretching on the muscles in the calf, the gastrocnemius (“gastroc”) and soleus, rather than the tendon. These are the muscles that taper into the Achilles tendon and are responsible for push-off during running and walking.
You can alter most of your calf stretches by changing your body position so that the stretch is focused higher in the calf rather than closer to your heel. Try this during a wall stretch. While leaning against the wall with one foot behind you, tuck your pelvis forward. You will feel the stretch higher in the calf, which is where I like my patients to feel it.
If the strain in the tendon is very close to the heel, eccentric loading exercises, which can easily be found online, are very helpful. These exercises contract the muscles while lengthening them. An example of this type of exercise is slowly and gently lowering your heel below a step while your forefoot is on the step.
Lastly, when in doubt, don’t mess around with your training. See your podiatrist and get the right diagnosis and the correct rehab plan so that you can safely reach your running goals.
Lori S. Weisenfeld, DPM is a 2017 Dashing Whippets Running Team Wellness Partner, and one of New York’s most highly-regarded sports podiatrists. Dr. Weisenfeld has an active practice treating runners, dancers, and other athletes. She has been a finish line medical volunteer with the New York City Marathon for the last twenty years. Dr. Weisenfeld’s practice can be reached at (212) 947-2320. Her office is located at 161 Madison Ave, #7NE (33rd Street), New York, N.Y. 10016.