Achilles Tendonitis: Caused by minimalist shoes?

author : AMSSM

comments : 4

A doctor's take on how to safely transition to minimalist shoes and how to treat existing injuries

Member Question from Kevlujohn

"I have been suffering from Achilles tendonitis for the past two months. I guess maybe it's now tendonosis? I got into the minimalist trend and bought a pair of Adidas minimal sneakers. I spend time around my yard in Vibram FiveFingers, and I wear driving mocs to work. (Summer in NY!) I completed Ironman Lake Placid last year and ran many marathons and have never had Achilles issues in my life. I have always used traditional running sneakers and actually use insoles in my work shoes. Could this change in work shoes, coupled with my new exposure to minimal sneakers be the direct cause of this Achilles tendonitis? Either way, my question is should I completely revert back and ditch this minimal fad/trend?
Thanks!"

Answer by Deanne Eccles, MD
Member AMSSM:

There currently is a great interest in minimalist or barefoot running. The theory of using less support to increase the strength of the intrinsic foot muscles and ankle stabilizing muscles makes sense. Most people have been running in heavily padded shoes with higher heels over the last 30-40 years. These cushioned shoes facilitate a running form where the heel strikes first when impacting the ground. However, there still is variability in running styles with some runners striking their heel and others midfoot striking. The stride length and cadence are different depending on the style of running; those that are mid foot strikers have a shorter stride length and higher cadence than those that heel strike. The main problem I see is that people get caught up in the idea of trying the new trend and don't transition as slowly as they should, which can result in injury.

In your case, I think that going from normal cushioned running shoes and dress shoes to the Vibram FF, driving mocs and Adidas minimal sneakers all at once may have been too drastic of a change. When you transition from heel striking to mid foot striking there is a change in the way the Achilles tendon is loaded: the mid foot strikers have more of an eccentric (lengthening of the muscle with a contraction of the muscle) load on the Achilles/calf complex and this can cause injury. Minimalist shoes may not work for every person. It depends on running style and ability to adapt, foot ligament flexibility and body weight. One thing that may be useful is for you to look at your style of running and see which part of your foot hits when you strike the ground. The goal is to re-train your style of running gradually so that you can build up the muscles supporting the foot and ankle over time.

There are many transition plans but I would look at changing over a 3-month period. A good way to start is to begin wearing the minimalist shoes around the house and with walking. Incorporate some balance work - single leg balance and then progress to balance work on a BOSU ball. Start engaging these muscles and get them used to the loss of shoe support. Pay attention to your foot strike when walking and make an effort to strike on the ball of the foot. Gradually add some running drills with the minimalist shoes to get used to the impact and increased force the muscles are accepting. Then move to regular runs starting at 1-2 miles and build up by a mile each week.

I don't think you need to give up completely on minimalist sneakers, but for now try using a more padded heel until your Achilles improves. I would work on balance and eccentric strengthening of the Achilles to rehab it. Once your pain is under control, consider the three-month transition as I mentioned above. If your Achilles acts up, slow down the transition. As your Achilles strengthens, you will be able to add more mileage.

It may be reasonable to use both types of shoes to allow you to get your mileage in as you are adapting to minimalist shoes. Don't try to push the mileage in minimalist shoes while you have an inflamed tendon as it may lead to a chronic tendinopathy. I would encourage you to get involved with formal physical therapy to help you with the strengthening exercises and really work on your balance strength. It is a time investment to transition to minimalist shoes but if you are motivated (and you obviously are with the IM completions!) you can do it. Don't be disappointed if you need to wear a more cushioned shoe for longer runs - you don't have to only wear minimalist shoes. Some training with both styles may be what you need to have a good balance.

Good luck and keep on training!

Deanne

Deanne Eccles, MD
Dean Clinic Wisconsin

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date: November 2, 2011