The Achilles tendon 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 irritation or inflammation, also known as Achilles tendinitis. Over time, a layer of scar tissue, which is less flexible than the tendon, can cover the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.
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Achilles tendinitis is characterised by dull or sharp pain anywhere along the back of the tendon but usually close to the heel on contraction - this can be felt tip-toeing or running. This pain might settle after a couple of miles and will often feel worse when getting out of bed. Other signs you might have Achilles tendinitis include:
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- A nodule (a lumpy buildup of scar tissue) that can be felt on the tendon
- Acracking sound (scar tissue rubbing against the tendon) when your ankle moves.
Pain in the lower portion of the Achilles region is more serious due to the limited blood flow to that region. If not treated, athletes can develop Achilles tendinosis, which is chronic inflammation with fluid. Over time, this can result in a degenerative tear of the tendon that shows as a lump in the area. If you feel a lump, consult a physio immediately.
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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.
Stiff running shoes, which can force the Achilles to twist, cause some cases. Runners who overpronate (when the feet rotate too far inward on impact) are most susceptible to Achilles tendinitis.
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A scan will confirm a chronic unresolved tendinitis and gait analysis with a video will show whether your pronation needs treatment.
Limited ankle flexibility?
Acracking sound scar tissue rubbing against the tendon when your ankle moves, lower calf muscle tears or simple heel tab bruising can all produce pain within the tendon.
How can you prevent Achilles tendinitis?
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Otherwise, to reduce swelling and ease irritation, Jordan Metzl, M.D., a sports medicine physician at the Hospital for Special Surgery in New York City suggests icing the area for 15 to 20 minutes several times a day until the inflammation subsides. You can also try anti-inflammatory medicines such as ibuprofen or anti-inflammatory creams. Self-massage may also help, and very gentle stretching can prevent shortening of the tendon.
If the injury doesn’t respond to home treatment in two weeks, see a doctor, physical therapist, or orthopedic surgeon. Surgery to scrape scar tissue off the tendon is a last resort as it’s not very effective and often just stimulates more scar tissue.
What’s more important than just addressing the symptoms is treating the root of the problem. One common culprit is tightness in the calf muscles. Stretch your calves or roll them out with a foam roller. Be sure to roll the muscles and not the tendon area, Metzl adds.
Another treatment option is strengthening the calf muscles with eccentric strength exercises, which apply load to the calf muscle while it is lengthened. To do this: Find a set of stairs that have a railing or wall for support. Place toes on the stair and let heels hang off. Use the railing to lift up onto your toes, then lower your weight down very slowly so that your heels fall below the level of the stair.
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.
Metzl suggests staying away from high-impact, weight-bearing exercises while your Achilles tendinitis is healing, and trying low-impact activities like swimming, pool running, or cycling in a low gear instead.
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To prevent the recurrence of Achilles tendinitis, it’s important to strengthen the muscles in your calves and feet. “The stronger the muscles, the less the loading force is on the tendon,” Metzl says.
Stretching your calves is also key for prevention. One of the best stretches 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. Drop both heels down and hold for 10 seconds. To increase the intensity of the stretch, keep one foot flat and lower the other heel. Then switch legs.
Achilles tendinitis is also linked to overstriding or when your foot touches down in front of your body. Metzl suggests focusing on improving your running form by shortening your stride and quickening your cadence to avoid heel-striking too heavily.
Other prevention methods you can try are experimenting with more supportive shoes or orthotics to help control foot pronation, avoiding running in worn-out shoes, easing into any running program, and incorporating rest into your training schedule.
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