Achilles tendonitis is the bane of many runners. The Achilles tendon connects the heel with the most powerful muscle group in the body, located in the back of your lower leg. The tendon is the hard cord that you feel behind your ankle.
The Achilles tendon is the common tendon for two muscles—the double-headed gastrocnemius and the soleus. Together these calf muscles are responsible for raising you up onto your toes (plantar flexion) and pushing off while you run and walk.
The gastrocnemius is a muscle that crosses two joints: the knee and the ankle. The functioning of these joints and the influence of other muscles on these joints has a significant effect on the tension that occurs within the Achilles tendon. For example, tight hamstrings impact the functioning of the ankle joint and the subtalar joint, and increase tension in the Achilles tendon.
The Achilles tendon does not have a rich blood supply. The blood supply to the proximal portion of the tendon comes from the branches of the calf muscles themselves. Because of this, the tendon is slower to heal, which drags out an Achilles tendon injury or tendonitis.
What Causes Achilles Tendonitis
Chronic Achilles tendonitis arises from ignoring pain in your Achilles tendon and continuing to run while injured. Tendonitis is the inflammation of the tendon. It is this tendonitis that causes the pain. If your Achilles tendon is getting sore, you should attend to it immediately.
Sudden increases in training can cause Achilles tendonitis, particularly excessive hill running or a sudden addition of hills and speed work.
A major contributor to Achilles tendonitis is excessive tightness of the posterior leg muscles—the calf muscles and the hamstrings. If your Achilles tendon is sore, perform only gentle calf stretching. Excessive stretching is not good for your Achilles tendon. In most cases, stretches put too much tension on an already tender Achilles tendon.
Two shoe construction flaws can also aggravate Achilles tendonitis. The first is a sole that is too stiff, especially at the ball of the foot. This means the “lever arm” of the foot is longer and the Achilles tendon is under increased tension, forcing the calf muscles to work harder to lift your heel off the ground.
The second shoe factor that can lead to a chronic Achilles tendon problem is excessive heel cushioning. Air-filled heels, which supposedly are now more resistant to deformation and leaks, are not good for a sore Achilles tendon. The reason for this is quite simple.
If you are wearing a shoe designed to give superior heel shock absorption, what frequently happens is that after heel contact, your heel continues to sink lower while your shoe is absorbing the shock. This further stretches the Achilles tendon at a moment when the leg and the rest of the body are moving forward over the foot. So, change your shoes to one without this feature. Make sure to avoid training in racing flats if you have Achilles tendonitis.
Treating Achilles Tendonitis
If you are suffering from Achilles tendonitis, the first thing to do is to cut back on your training. If you are working out twice a day, change to once a day and take one or two days off per week. If you are working out every day, cut back to every other day and decrease your mileage. Training modification is essential to treatment of this potentially long-lasting problem. You should also cut back on hill work and speed work.
Applying ice after running is also very important. Icing is an anti-inflammatory treatment, and remember, tendonitis is an inflammation issue. Be sure to avoid excessive stretching. Accompany the first phase of healing with relative rest, which doesn't necessarily mean stopping running but just cutting back in training.
If this does not help quickly, consider adding a quarter-inch heel lift into your shoe. Do not worry that you will become dependent on this; instead, concentrate on getting rid of the pain. Don't walk barefoot around your house and avoid excessively flat shoes.
Clinical treatment of Achilles tendonitis initially consists of the physical therapy manual techniques and possibly modalities such as electrical stimulation and ultrasound. Your sports physician or physical therapist should also carefully check your shoes. Supportive shoe inserts such as Superfeet® can help control excessive pronation.
These methods can be incorporated in a program of Achilles tendonitis rehabilitation therapy that also includes gentle stretching and graded strengthening exercise. Orthotics with a small heel lift are often helpful. A resting night splint can be used for tough cases.