Member Case Study: Heel Pain and Half Marathon

author : AMSSM

comments : 0

It sounds like you have insertional Achilles tendonitis. This can be created simply by continuous use and higher mileage or by a minor injury such as missing a step.

Member Question

I have been following a beginner half marathon plan for three months with no problems until this week. This is my final heavy week with a long run of 10 miles on Sunday then next week is my taper week. Three days ago I woke up and could barely walk because of pain in the back of my heel just below my Achilles tendon.

It hurts bad in the morning for an hour or so and then seems to loosen up for the rest of the day. I can run in the evening and have very little pain if any. What could this be? Also, what should I do about the rest of my training leading up to my half on Dec. 10? I am scheduled for a 5 mile run tonight and a 10 mile run Sunday. Next week is low mileage...taper. Any suggestions are greatly appreciated.

Before I started training for the half I rarely ran more than 15 miles a week. I have been in triathlon for several years, but just started focusing heavy on my run (the last 6 months or so).
 

Answer

Thanks for your question. Sorry I could not provide an answer before your race. It sounds like you have insertional Achilles tendonitis. This can be created simply by continuous use and higher mileage or by a minor injury such as missing a step. It does not take a fall or twisted ankle to create pain, even simply miscalculating the height of a curb or having to stretch to get over a puddle of water can make you land funny creating tension, in this case the Achilles tendon.

It is very typical to have increased pain upon rising in the morning, as you have slept much of the night with your foot pointed down (plantarflexion). This tension then must be “worked out” as you take the first steps of the day. To treat this, increase your stretching routine to include aggressive Achilles stretching multiple times per day, I recommend stretching three times per day. Wearing a heel lift in your shoe will also decrease the tension created at the insertion site with every step you take. If you like them, they can be worn in all shoes including your running shoes. I would recommend a significant heel lift, we use those made out of felt as we are trying to actually lift the heel up, not just cushion the surface. Icing after your runs or workouts with an ice cup will also decrease the local inflammation.

As for your training, if you are not having increasing pain I feel it is safe to continue running. I would not try to increase volume or effort during the treatment time, but just maintain. Your taper has come at a convenient time, so take advantage of this. If your pain does increase then rest is warranted and can come in the form of just pure rest or modification of workouts to limit them to non-impact activities. Good luck with your training.

Todd W. Arnold, MD
Member AMSSM
Indianapolis, IN

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date: December 18, 2006