Achilles tendinitis and heel pain

Brad Marcus

Would appreciate any advice out there on this topic. I got through the IM season avoiding injuries this year. I was very cognizant of not doing anything that would get me into trouble - from pickup basketball games to bungee jumping! After the season, I've been mostly focused on training for a couple of half Mary's, and I ran a trail race a couple of weeks ago, which beat up my ankles and feet a bit from the unevenness of the footing and the lateral movement that I'm not used to. Couple this with me mixing in a new running shoe over the last week or so that has slightly less drop - moving from 11/12mm to 7/8mm drop - which may or may not be a factor.

Now I'm having some pain and discomfort in my heel and what appears to be Achilles tendinitis. I'm feeling it when I get out of bed in the morning and also when I run (more so running inclines). It's not too severe, but I would hate for it to get there. I have a half Mary scheduled in 1.5 weeks that I was planning on hitting fairly hard. Any advice as to how to treat this or work through? I've had this before, but not in a few years.....

Satish Punna

I have had this problem before.

the decreased drop may be a factor: can you go back to a slightly higher drop shoe?

Rolling out any sore spots on your calves with a lacrosse ball, foam roller, or stick (in my order of preference) may help 2-3 times per day.

The best exercise is eccentric heel drops to flat surface if you have 'insertional' achilles tendinitis or to below flat if you have non-insertional type.  Use your other good leg to lift yourself up then s l o w l y lower down with your affected leg 10 reps several sets knee bent and straight. 

http://www.runningwritings.com/2011/09/injury-series-flat-eccentric-heel-drops.html

good luck!

rlh2000

Agree with Satish, would also add ICE and possibly the night splints meant for plantar fascitis. Since you have pain when you get up in the morning, such a splint would keep your ankle flexed and the achilles more lengthened overnight.

rlh2000

Oh- also stretch your hip flexors! In tight hip flexors, achilles can get ovrloaded trying to compnsate!

Junior Tereva

Eccentric heel drops on a step 3 x 45 or till it burns 3 days a week. Graston Technique helped as well.

Cheers,
Junior

morpheus

good tips.

what do you guys have to say about Brad attacking that 1/2 mary in 10 days?

I'd say ''Don't risk it''. But, that's only because tightness and noticeable soreness are early red flags for me. And, if I run hard (or hills) thru it, I'm voluntarily signing up for 6 weeks of no running soon after.

What do you think?

Jacklyn Moore

I've been having similar trouble. Thank you for posting. Is this an injury that should be active rehab or lay off running for several weeks? 

Leslie Knight

Really, it depends on long term goals and pain level. If thisbisbtheblast race of the season and the pain is mild and not worsening with some training runs, I say go for it. If the pain is lasting between runs, or is bad or worsening , then lay off. You could take some time completely off land running, do some pool running if it doesn't hurt and then do the race if it's really important to you. Recognizing that you make be out completely for several months in the out season. Sounds like some plantar fasciitis starting in the foot and that does not get better with continued irritation.

Brad Marcus

Thank you all so much for all the great info - That's why this team rocks!

@Satish - great info and thank for link...I read it over and that's really good and useful stuff.

@Rachel - Ive iced in years past when I've had this...actually it was MUCH worse then and it helped a lot. My preferred method is to take a big container of ice water and soak my entire foot in it. Also interesting what you mentioned re hip flexors...mine are notoriously tight and ever issue ive ever had seems to stem from my hips! If I remember right, aren't you a physical therapist? That would make sense.

@Junior - school me on the Graston?

@Chris - at this stage, I'll go for it. It's not so bad that I am in agony and as @Leslie notes, this is my last bunch of races for the season before dropping into the NOV OS. I've had this worse, but am always interested in how and why it occurs. The amount of training I'm doing now doesn't stack up to what I did through my IM build...so it's kind of strange. I'm almost positive that the trail race set it off....there were some super steep inclines in the race with really bad footing and I was going as fast as I could. It has never progressed to the plantar part of my foot in the past. Its always more of a heel issue and may be an inflamed bursa.

@Jacklyn - hope yours isn't too bad!

Thanks again guys...I'll keep you in the loop with my progress!

William Jenks

You didn't mention how old you are. I just turned 50 this year and have a good history of not-too-much overuse injury. However, this year I also had some heel-based achilles tendonosis and saw PT for it. I was told that what I had was a degenerative condition, not an acute injury. If you're aging a bit, this may also be the case. The good news is it's controllable and doesn't get worse fast if you're not stupid; the bad news is that the degenerative variety (I am told) heals slowly and may never be entirely resolved.

That said, I do strongly endorse the eccentric heel drops if you want to try to self treat.

rlh2000

Yep Brad, I'm a PT. The tight hip flexors are often overlooked in achilles issues, but think about what you need to have your leg extending behind you when you run. If your hips are tight, you are requiring much more flexion at the ankle and thus stress on the achilles. In addition to eccentric heel drops, I like a lot of single leg balance- it causes all those stabilizing muscles to kick on, the sort of muscles that help with stability on trail runs.

Junior Tereva

I had big lumps on both Achilles around the ankle region that had built up over the years my PT recommended using the Graston technique to break up scar tissue and adhesions around the calf and Achilles region. I think I had 12 sessions or maybe more this was early 2011.
Physical Therapy session:
10mins warm up on bike
20mins stretching program
20mins Graston
10mins Ultra-sound
Stretching

There’s a lot of information about the Graston technique on the web…check out this you-tube link.
http://tinyurl.com/kfc5zpr

Jacklyn Moore

@ Satish- I have started both types of heel drop. The below flat has really got my achilles fired up. Do I drop my heel as far as it will go? Allowing for a good stretch at the bottom. Or stop mid way? 

I'm really focusing on hip flexors too. I've had problems with them being tight in the past. This flared up from riding my husbands touring bike with flat pedals for 35 miles with my father in-law. 

Thank you for helping me too. I've been trying to handle this by myself. 

Satish Punna

With the heel drop, in my experience it makes my achilles problem feel better immediately- I suffer intermittently (very uncommon now though thankfully) from the insertional type.  

I think if it hurts you, don't do it.  The proper way to do either exercise though is to make sure you use your other leg or both legs to lift up then slowly lower down on the affected leg.  Really slowly like over a count of 10.  

I do my exercises on a set of stairs where i can also use the handrail to lift up.  You don't want to turn this into a calf raise exercise. 

Rolling out your calves with a tennis ball or lacrosse ball, i.e sitting on the floor legs straight with your weight on the ball and rolling it around on hot spots in the fleshy muscle part may help too.  It helped me.  

William Jenks

Seconding Rachel...in my rehab for this similar-sounding problem, I was also asked to do lots of 1-legged balance work.

Scott Alexander

I tried the Altra zero-drop shoes a few years ago, which worked well for about 2 months, then had a medium case of Achilles tendonitis. Switched back to 3-5mm drop shoes, and added PT (still doing it proactively), and all has been good. Actually, my running (form and performance) has actually improved from it as well!

Definitely get a PT analysis and workup plan to address the issues/imbalances that we all seem to have in the whole "chain" from toe to lower back!