Pain along the back of your heel or ankle may be Achilles tendonitis, a relatively common injury.

Achilles Tendonitis: Understanding and Preventing Heel Pain

If you’re experiencing pain at the back of your foot, ankle, or lower calf, you may have Achilles tendonitis. This problem is particularly common among runners, though it can occur after any repeated physical activity from hiking to gardening.

The Achilles tendon is the large tendon that connects the two major calf muscles to the heel bone. Don’t confuse it with the plantar fascia, which is a thick, connective-tissue, support structure that runs along the underside of the foot. In severe cases of Achilles tendonitis, the pain may be accompanied by a bump or nodule on the tendon.

Tendonitis occurs when the Achilles tendon is forced to work too hard and becomes inflamed, which in turn causes it to build up scar tissue and stiffen. If an inflamed Achilles continues to be stressed, it can start to tear or rupture.

Preventing Achilles Tendonitis

If you run, your running form is the main factor affecting your risk for Achilles tendonitis. Here are issues to watch out for:

1. Coming down hard on your heels. A hard heel-strike increases the risk of achilles tendonitis. The heel is not as springy as many people think; the heel is essentially a bone protected by thick skin and a fat pad, so you want to set it down gently. Striking on your heel also slows your momentum, forcing you to push off again, and this places more cyclical load on the tendon as the calf contracts to push off.

What to do: Try to achieve an even or mid-foot strike and pick your feet up, rather push off.

2. Tight calves. When your calves are tight, they affect the flexibility of your ankles, feet, and their articulations. How do the calves get stiff? Some factors may include wearing high heels, forefoot running, or cross-training with sports or activities which involve sprinting or jumping. Force is equal to mass times acceleration; any time there’s a change in acceleration or deceleration, you’re pulling on the Achilles.

What to do: Stretching your calves can help, but many people tend to over-stretch. Calves get stretched with normal walking as long as you walk enough. One simple stretch I recommend is walking on your heels. This strengthens the shin muscles and stretches the calves out. Another technique is to try is walking backwards up a hill, which works the calves. The calves are under less stretch, and this may be a good warm-up prior to more agressive stretches and exercises.

3. Wearing the wrong shoes. If your running shoes are too flexible or just getting old, your foot and ankle may have to contend with too much play. The Achilles tendon may be working too hard to balance the foot. Also, if you innately have too much sideways motion through supination and pronation, you may be particularly susceptible. One sign may be significant asymetrical wear of the soles of your shoes.  Barefoot running may be risky because, for many people, it makes you so apprehensive you can’t really relax, and the whole key is to relax.

What to do: Go to a reputable running shoe store and get your shoes fitted by a professional. Orthotics may also help to combat over-pronation.

4. Overtraining. Overdoing it on hill running and speedwork can stress the Achilles.

What to do: Be careful to increase speed and hill running gradually and ease up if you’re feeling pain.

Treating Achilles Tendonitis

When you first notice pain, ice the area to ease inflammation. If you like, you can also take aspirin or ibuprofen. Massaging the area yourself or getting an acupressure massage may help. I don’t necessarily recommend that you stop running altogether, but relax your training schedule and alternate running with other forms of exercise such as swimming, yoga, and bicycling.

If you’re still experiencing pain after a few weeks, see a physical therapist for an evaluation, gait analysis, and recommendations.

Brian Soo is a senior physical therapist at the Kaiser Permanente San Francisco Medical Center who works inpatient, outpatient, and in sports medicine.  A recreational runner for many years, Brian also bicycles, plays racquetball, and most importantly, paddles on a 20-person Dragon Boat team that competes internationally and practices three times a week. He also enjoys active video games and believes they can be an excellent complement to an overall fitness regime.