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Achilles Tendonitis: the Runner's Heel Pain

By Dr Christopher Segler

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Published: 03Nov2008
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According to Greek mythology, when Achilles was born his mother tried to make him immortal by dipping him in the river Styx. However, when she dipped him in, she forgot the spot on the heel she held him by, which left one small area unprotected. In the end, Achilles was struck by an arrow in his vulnerable heel and was killed. Achilles shares his vulnerability with the rest of us entirely mortal runners, and that is why the tendon which connects the calf muscles to the heel bone bears his name today. The Achilles tendon is the largest, strongest tendon in the human body, but it is also the tendon we rupture most often. Anyone who is active can suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

If you are out running hills and feel a sharp pain or dull ache in the back of the leg down near the heel, this could be Achilles tendonitis. If you feel along the course of the tendon (where it is mobile just above your heel bone) and you have tenderness, this is most likely Achilles tendonitis. Don't ignore this. Ice the area and decrease your activity level. Avoid hills or speedwork until it subsides. If it doesn't quickly get better, see your podiatrist. Otherwise you might end up sidelined for four to six weeks.

The best way to prevent Achilles tendonitis is to stretch and warm up before intense speed workouts, hill repeats and long runs. This keeps the tendon pliable, preventing micro-tears. Stretching can improve blood flow, enabling a speedy recovery if you do become injured. Stretch after a short warm-up; never stretch aggressively when you muscles are cold.

Symptoms of Achilles tendonitis can include mild pain after exercise or running that gradually worsens, a noticeable sense of sluggishness in your leg, and episodes of diffuse or localized pain, along the tendon during or within a few hours after running. Other symptoms can be swelling, morning tenderness in the Achilles tendon, or stiffness at the back of the leg that generally diminishes as the tendon warms up with use.

Treatment depends on the degree of injury to the tendon, but normally includes rest. It may even mean a total withdrawal from running or exercise for a week, or simply cross-training with another exercise, that does not stress the Achilles tendon. Treatment can also include non-steroidal anti-inflammatory medication or orthoses, which are devices designed to help support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert.

Other treatments are bandages specifically designed to restrict motion of the tendon, stretching, physical therapy, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors that work against the Achilles tendon. If the tendonitis is mild, simple modifications of activities may help. Decreasing mileage, running on flats instead of hills, and backing off the activity level until there is no pain with exercise can allow the tendon to heal. In general, ice is much better than heat for tendonitis.

Some medications can increase the risk of Achilles tendon ruptures (complete tear). If you are taking steroids (prednisone) or flouroquinalone antibiotics (Cipro, Levaquin, etc.) you should not exercise unless you have discussed this with your treating doctor. You may have seen in the news where the FDA recently posted a strong "Black Box" warning about these antibiotics and the associated risk of tendon ruptures.

A torn Achilles tendon is serious. Interestingly, it is not always painful. However, there is usually significant weakness and difficulty standing up on the toes if this has occurred. Any suspected torn tendon can be serious and should be evaluated by a podiatrist. In rare cases surgery may be needed to repair the tendon.

If you happen to be a marathon runner in training for battle on the course; warm up, stretch, and stick to your training program. Do not run through the pain if you think you have Achilles tendonitis. If you are a Trojan War hero in battle, and you see any arrows coming your way, stay low and keep moving!

Dr. Christopher Segler is an Ironman triathlete and award-winning foot and ankle surgeon practicing at the Ankle & Foot Center of Chattanooga. For more information about Achilles Tendonitis, runner's heel pain, or other common causes of foot pain, you can order a FREE copy of his book, My Fit Feet, by calling toll free => (888) 701-6099 or visit MyRunningDoc.com.

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