Achilles Heel Pain; Don't Let It Slow Your Run

Published: 05th November 2008
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We all know of Achilles, the Trojan War Hero of Greek Mythology. His mother tried to make him immortal by dipping him the river Styx. Unfortunately she missed a spot on his heel. So the story goes that he was struck by an arrow in that spot and he was killed. The largest tendon in the body connects the calf muscle to the heel bone. This tendon is named for Achilles. Just like the fallen war hero, all runners can be vulnerable in this spot. The Achilles tendon is the one ruptured most often. In order to stay active, it is important for athletes to know how to avoid inflammation and injury to this 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. Until the pain and inflammation resolves, you should avoid stressful activities like speed work or running hills. If it doesn't quickly get better, see your podiatrist. Otherwise you might end up sidelined for four to six weeks.

One of the most effective ways to prevent injury to the Achilles tendon is through a good warm-up and stretching routine prior to long runs, hill repeats and speed workouts. 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.

Patients with Achilles tendinitis often report a sense of sluggishness in the leg, diffuse pain around the Achilles tendon, or mild pain either during or after exercise that usually worsens as they run. 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.

The severity of the injury to the Achilles tendon will help determine the treatment. But in most cases, rest is part of the treatment. It might be necessary to stop running and other high impact exercise, although often you can cross-train and cycle, as long as there is no pain or stress to the healing 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). Whenever taking medications such as oral steroids or antibiotics (prednisone, 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. For some reason, not all patients report that it is 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 before you stretch, but most of all, don't deviate from 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

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