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Achilles Tendonitis

By John M. Martinez, M.D.
4/1/06

Achilles tendonitis is a common running injury that involves the tendon at the back of the ankle. The tendon connects the calf muscles to the heel and is important in the flexion and push-off phase in running. Proper training, running form, footwear, and early treatment may help prevent this injury from limiting your running.

Signs & Symptoms
Symptoms include pain or swelling at the back of the calf or heel. Typically the pain is 1 to 3 inches above the heel - just above the back of the running shoe. The pain may be worse when pointing the toes down (plantar-flexion).

Causes and Risk Factors
Risk factors include a rapid increase in distance and running intensity, or running hills. Excessive over-pronation of the foot (rolling of the foot inward when standing) may also cause Achilles tendonitis.

Treatment
In the initial inflammatory stage - ice, anti-inflammatory medications (such as ibuprofen), decreasing running miles and stretching may prevent Achilles tendonitis from becoming chronic and painful. An evaluation of your running shoes, feet and running form may be helpful.

After several weeks, a chronic tendonitis (also called tendinosis) can develop. In this stage of the injury, although there is less swelling and inflammation, the tendon can become less flexible. At this point, anti-inflammatory medications are less effective, but physical therapy for stretching and strengthening the calf may be helpful.

Stand on the edge of a step, facing the steps as if you were going up the stairs.

Place the balls of your feet and toes on the step

The heels of both feet are hanging off the edge of the step.

Slowly lower the heel of your injured leg, so that it drops below the step. There should be a slight stretch in the calf muscle

This is the eccentric, or lengthening part of the exercise.

Return to the starting position using your uninjured leg.

Repeat this exercise 10 to 15 times as the pain allows. Stop if the pain becomes worst.

If the injury persists, see your doctor or another medical provider for an examination.

Prevention
Proper running shoes, as well as regular stretching, a gradual increase in running mileage and proper recovery are the best preventive measures.

Eccentric strengthening exercises (lengthening the muscle while under stress) have been highly effective in curing Achilles tendonitis. The best eccentric exercise for the Achilles and the calf muscles is weight-bearing plantar flexion of the foot.

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Achilles Tendonitis