Healing Above the HEEL- A Guide to Achilles Pain

The Achilles tendon is the largest and strongest tendon in the body. In fact, the tendon transmits forces nearly 4x body weight during walking and 8x body weight during running. Although the Achilles can withstand a (literal) ton of force in some individuals, this powerful connector between your calf muscle and heel isn’t spared of dysfunction from time to time.

If you are experiencing pain in this area, chances are you have overstressed this tissue by simply doing more than normal. But other causes of Achilles pain can be attributed to footwear, training surfaces, bone spurs, or even certain medications. Observational data suggests that up 40-50% of runners will experience a bout of Achilles pain. However, Achilles pain is common in both athletic and non-athletic populations as well.

Common signs and symptoms of Achilles Tendinopathy:

• Morning pain and stiffness
• Pain with walking or running uphill
• Difficulty walking up or down stairs
• Difficulty performing a heel raise
• Swelling or warmth in the heel or along the tendon

Tendinopathy vs. Tendonitis:

While you may have heard of Achilles tendonitis in the past, leading researchers have been using the term tendinopathy in the most recent years to recognize that tendon injuries are more than just inflammation. This distinction is very important when it comes to treating the differences between the two issues.

Should I be worried about tendon ruptures?

The chances are low. Approximately 4% of individuals diagnosed with Achilles tendinopathy ultimately sustained a rupture. The incident of Achilles tendon ruptures in the general population is around 5-10 per 100,000 individuals. 80% of these cases occur during competitive or recreational sporting events.

Where to start?

Modify Activity Level: Although complete rest of a tendon is almost never recommended, temporarily limiting bothersome activities will help the pain decrease while maintaining mobility of the ankle joint.

Heel Lift: Adding a heel lift to your shoe will off-load the Achilles tendon by placing it in a shortened position. Your PT will be able to assess if adding a heel lift will be helpful for your specific case.

Reduce Compression: Avoid wearing shoes that are putting lots of compression on the sore area of your heel.

Exercise: Research supports eccentric loading as the gold-standard of treatment for mid-portion Achilles tendinopathies. Your PT will be your guide on what exercises are best for your case following an evaluation. You can expect to do some heel raises!

Prevention: Of course the best way to treat an injury is to prevent it! Here are some tips to avoid achilles pain.

• • • • • Strengthen calf muscles, allowing your Achilles tendon to tolerate higher forces
        • Replace worn out shoes
        • Maintain calf flexibility
        • Increase your activity level gradually
        • Cross training