Chronic Sore Achilles Heel

Whenever we have a question on the “Ask Marsh” page that could apply to lots of folks, we’ll repost the Q&A here. This one came from Rich Chipman last week:

Completed my first 50K in May. After a few months, started having trouble with chronic sore Achilles heel issue in right leg. I run every day (have run outside every day for 2,000 days in a row). Fitness level is still good as I train for my first 50 Miler, but running with (thru) some bothersome pain that changes my gait a bit. Changed shoes, tried more trails, cut back mileage some (down to 35-40 a week), ice after runs. Ideas other than breaking my streak? Thanks.

My response to Rich, which echoes much of what I wrote about in my more general post on runners’ foot health:

Congratulations on your first 50k! In my experience, a lot of Achilles pain actually comes from tight calf muscles. After running, slow and easy, for a mile or two to warm up, stop to gently stretch the back of your calves and your Achilles. You can do this by finding a stair (or anything of similar height, where you can drop your heal off the back). Place your forefoot on the stair and slowly and gently drop your heal. Do not bounce or over stretch. Hold the stretch for about 15 seconds and repeat about 3 times on each side. You should feel a gentle stretch, not pain. If the stretch irritates the tendon, stop. Do this gentle stretch again at the end of your run.

There are a few other things that come to mind that might be irritating your Achilles.

  • The first is heat radiated up from the pavement, which can really be a problem in the summer. Try to run earlier in the morning or later in the evening to avoid the heat, or run on trails as you have been doing.
  • The second is irritation caused by even the slightest pressure from the back of your running shoe and even elastic from a low cut sock. During my run across America I had Achilles tendonitis. One thing that helped a lot was to cut a 1/2 to 3/4 inch slit down the back of my shoe to alleviate ANY pressure on my Achilles. If you’re worried about “ruining” a pair of running shoes, remember: shoes are replaceable, your body isn’t. Also wear a sock that is soft and has no elastic applying pressure to that portion of your tendon.
  • Third is, of course, the repetitive nature of running which loads the tendon. I would suggest that you reduce your mileage further for a couple of weeks and mix in some walking and gentle hills/trails. Also, shorten your stride – you’ll be surprised at how much this can help!

You are on the right track with the icing after running, and be sure to take an anti-inflammatory as directed. Keep up the regimen of an anti-inflammatory for few days even after the symptoms subside, as I hope they do. Think about doing that 50 miler in the future. It will be there waiting when you are healthy. That’s the key: getting yourself healthy again.

marsh

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2 Responses to Chronic Sore Achilles Heel

  1. Another possibility is that he could also have a calcaneal spur irritating the achilles tendon. If the pain is with every step of your running right from the start, then more weight on calcaneal spur. If its after running for sometime say more than 10 mins after starting, then more weight on calf muscle strain as outlined above.

    Dr Gauresh.
    Orthopedic Doctor´s last blog post ..Thumb Spica Splint or Cast

  2. Hi Guys,
    I’m a two time Ironman finisher and I’ve had my share of Achilles heel pain problems. Firstly I think you are spot on with your advise on “irritation caused by even the slightest pressure from the back of your running shoe and even elastic from a low cut sock”. I mean, surely you have a pair of worn out running shoes. Try it with them first and see if it works.
    My experience with anti-inflammatory is that they can remove some pain but they will not cure the problem. It has got something to do with that Achilles tendonitis isn’t an inflammation. It’s blood veeners growing into your tendon trying to repair damaged tissues.
    My number one advise on Achilles heel pain is Eccentric calf raises. They really do the job and I truly recommend it.
    Best!
    Lars

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