The Achilles is the large tendon connecting the two major calf muscles–the gastrocnemius and soleus–to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that’s Achilles tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.
Image © American Academy of Orthopaedic Surgeons
Identifying symptoms of Achilles tendinitis
Achilles tendinitis is characterized by dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. Other signs you might have Achilles tendinitis include limited ankle flexibility, redness or heat over the painful area, a nodule (a lumpy buildup of scar tissue) that can be felt on the tendon, or a cracking sound (scar tissue rubbing against the tendon) when the ankle moves.
Causes of Achilles tendinitis
Tight or fatigued calf muscles, which transfer too much of the burden of running to the Achilles, can be brought on by not stretching the calves properly, increasing mileage too quickly or simply overtraining. Excessive hill running or speedwork, both of which stress the Achilles more than other types of running, can also cause tendinitis. Inflexible running shoes, which force the Achilles to twist, cause some cases. Runners who overpronate (their feet rotate too far inward on impact) are most susceptible to Achilles tendinitis.
Prevention and treatment of Achilles tendinitis
If you start experiencing Achilles pain, stop running. Take aspirin or ibuprofen, and ice the area for 15 to 20 minutes several times a day until the inflammation subsides. Self-massage may also help.
Once the nodule is gone, stretch the calf muscles. Don’t start running again until you can do toe raises without pain. Next, move on to skipping rope, then jumping jacks, and then gradually begin running again. You should be back to easy running in six to eight weeks.
If injury doesn’t respond to self-treatment in two weeks, see a physical therapist or orthopedic surgeon. Surgery to scrape scar tissue off the tendon is a last resort, but not very effective and often just stimulates more scar tissue.
Try these alternative exercises: Swimming, pool running and bicycling (in low gear). Stay away from weight-bearing exercises.
To prevent the recurrence of Achilles tendinitis, strengthen and stretch the muscles in your feet calves and shins. A good way to do this: Sit on the floor with a weight taped or strapped to the front of one foot. Bend the knee at a 90-degree angle, with your heel resting on the floor; then lift the weight by pulling the toes toward you. Lower, and repeat. You can also do toe raises to help strengthen your calves.
Another great stretch for the Achilles is also the simplest. Stand on the balls of your feet on stairs, a curb or a low rung of a ladder, with your legs straight. Drop both heels down and hold for a count of 10. To increase the intensity of the stretch, keep one foot flat and lower the other heel. Then switch legs.
Wear motion-control shoes or orthotics to combat overpronation, and don’t run in worn-out shoes. Ease into any running program. Avoid hill work, and incorporate rest into your training schedule.