Achilles Tendonitis

author : AMSSM

comments : 1

Six weeks ago I felt a tug on my achilles during a treadmill run. I had really been finding my stride the last few weeks ramping up mileage again for the running season.

Member Question

Six weeks ago I felt a tug on my achilles during a treadmill run. I had really been finding my stride the last few weeks ramping up mileage again for the running season. I have been seeing a specialist who said the strain wasn't bad. I had a few weeks of treatment and another few weeks of no running. Last Saturday, I did some running at half speed, on really flat course. It turned out I ran five miles fairly pain free. No real pain. Iced it and stretched it. 

Today. I went for a half speed run. I really only wanted to do three miles. But wow. About two miles in it felt like it did all those weeks ago. I had to "walk" home. As I sit here K taped to within an inch of my life, I find myself asking if this seasons training is toast?  I wonder if I can heal this before my next race in a few months? 

What to do what to do ? 

Answer from David Westerdahl, MD  FAAFP  RMSK
Member AMSSM

Calf and achilles tendon injuries are common in runners. From reading about the injury above, I suspect you experienced a muscle tendon junction strain as the calf muscle transitions into the achilles tendon. Typically, an injury to the muscle tendon junction where the calf muscles transition into the achilles tendon will present as a tugging sensation or like a tennis ball hit you in the back of the leg. The calf muscles (gastrocnemius and soleus) form the achilles tendon which attaches to the posterior ankle. Achilles tendonitis is a common overuse running injury that can cause tightness and pain in the heel area at the beginning of a run and typically eases up as the tendon warms up. These injuries typically resolve over a short period of time, but the duration of symptoms typically depends on the severity of the injury. Also, these injuries are prone to recurrence for several months.

In my practice, I see this injury pattern commonly in runners who over-pronate, have tight achilles tendons, and/or use minimalist shoes. While I feel minimalist shoes can reduce certain types of running related injuries, in this situation they may increase the eccentric load on the achilles due to running on the mid/forefoot which can contribute to achilles tendon tightness and pain.

The calf muscles and achilles tendon connect to the heel and when the calf muscles flex, they cause the heel to rotate the direction of the foot (plantar flexion) allowing the calf muscles to pull that allows for walking, running, and other movement related activities.

Treatment of this injury in the acute phase requires rest, icing, and elevation. I recommend against ACE wraps, but for mild to moderate muscle strains, a compression sock can be useful. For more severe injuries causing limping, swelling, and/or bruising, I’ll commonly immobilize my patient in a walking boot and possibly have them use crutches for several days. After an initial period of rest to allow for early healing and better walking, I’ll initiate stretching and strengthening exercises and begin eccentric exercises three weeks out from the injury. I also encourage the injured athletes to perform low impact cardio such as biking and swimming beginning 1-2 weeks after the injury depending on severity. As time progresses, most athletes are able to progress back to running, but it is common for mild exacerbations of the pain to occur and slow down recovery. Compression sleeves/socks may improve muscle firing patterns and I recommend them to individuals recovering from their injury, but medical studies have yet to prove their benefit. When these injury recurrences occur, its important for the athlete to temporarily back down on their running and look at other factors such as running speed, distance, surface, footwear, and flexibility.

Prevention of this injury is hard to do, but most individuals experience this injury between their mid 30’s to mid 50’s due to reduced flexibility and chronic age related tendon changes. Its very important to try to maintain good flexibility, run in proper footwear, and listen to your body because today’s twinge can become a bigger problem if ignored.

David Westerdahl, MD  FAAFP  RMSK
Sports Health  I  Director of Rehab
Department of Orthopaedic Surgery
2950 Cleveland Clinic Blvd I Weston, FL 33331 I (954) 659-5430 I (954) 659-5427 Fax
www.clevelandclinicflorida.org

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date: December 15, 2013