Pain in My Heel: Achilles Tendonitis

photo by markusram
Note: I’d never, ever wear these high heels with my knee injury.

Because having two bum knees isn’t bad enough, my body went ahead and broke something else: my Achilles tendon. All right, so it’s not broke broke. But, whatever. It’s inflamed, it hurts, and it is a bona fide injury. Yippee.

I learned about my new injury today when I visited the podiatrist after a couple weeks of heel pain. It started in the back of my heel, the part that rests on the couch when I stretch out my legs. I figured I was bruising my heel by constantly sitting with extended legs—at work they even rest on top of my ancient tower computer. Then the ache increased and spread to the bottom of my heel. The injury isn’t as painful or debilitating as the chondromalacia in my knee. That said, I hope to halt the pain before it turns into a major problem.

So, what’s the Achilles tendon?
It’s the largest tendon in the body and connects the calf muscle to the heel bone. The Achilles tendon makes it possible to rise to your tiptoes and propel yourself into a walk or run.

What is Achilles tendonitis?
When the tendon becomes inflamed, you can feel pain in the back of the heel or above and below it.

What causes Achilles tendonitis?
Aside from bad luck (I’m starting to think I have a surplus of that), there are a number of problems that can cause Achilles tendonitis:

• Suddenly running further or faster than you’re used to
• Starting a fitness routine too soon after a break (as in too much too fast)
• Adding stair climbing or hill runs to your routine, which requires the tendon to stretch more than normal
• Feet that overpronate (roll inward) can twist the tendon and put extra strain on it
• Changing your footwear. Wearing high heels can shorten the tendon and calf muscle so you stretch and strain it while running
• Having naturally inflexible calf muscles
• Trauma from a sudden contraction of the calf muscles during exercise
• A series of small tears over time due to overuse

What are the symptoms?

• Pain after exercise that gradually worsens over a few days
• A feeling of sluggishness in your leg
• Pain along the tendon during or shortly after running
• Morning tenderness where the Achilles tendon attaches to the heel bone.
• Stiffness that dissipates during use as the tendon warms up
• Mild swelling

Why should I care?
You mean, aside from pain? Untreated tendonitis can increase inflammation and lead to a ruptured tendon. What that means for you: Worse pain and a longer, tougher recover.

How do you treat Achilles tendonitis?
For starters, stop running six miles a day. No, really; continued activity can hamper recovery. My doc says I can stick to the exercise bike and elliptical trainer as long as I perform a set of six physical therapy exercises (more on that below) before and after.

Aside from stretching daily, treatment may include taking anti-inflammatories or wearing custom orthotics that correct overpronation and relieve stress on the tendon. If your injury is bad enough, your doctor may tape your leg to support the tendon or use cortisone injections to stop inflammation.

What physical therapy exercises are prescribed?
My doctor ordered me to complete the following six exercises twice a day:

1. Towel Stretch: Sit on the floor with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward your body. Keep your knee straight. Hold for a count of 30; repeat three times.
2. Standing Calf Stretch: Stand facing a wall with your hands at eye level. Put your injured foot behind your other leg and keep its heel on the floor. Turn your injured foot inward slightly and bend your leg a little. Slowly lean into the wall until you feel a stretch in your calf. Hold for a count of 30; repeat several times a day.
3. Plantar Fascia Stretch: Stand with the ball of your injured foot on a stair and slightly pointed outward. Let your heel drop to the step below and feel a stretch in the arch of your foot. Hold for 30 seconds; repeat three times.
4. Toe Raises: Stand with feet hip width apart. Rock back onto your heels so your toes raise off the ground. Hold for five seconds. Repeat 10 times. Do three sets of 10 raises.
5. Heel Raises: Rise onto your toes, hold for five seconds, then return to the start position. Repeat 10 times. Do three sets of 10.
6. Single Leg Balance: Balance on your injured foot. Start with your eyes open, then try to do the exercise with your eyes shut. Hold the position for 30 seconds. Repeat three times.

How long do I have to live with this?
That was my first question. I like to get that out of the way early because after living with knee pain for more than years I know it’s really the most important. My doctor said the injury could take six weeks to fully heal.

Can I prevent it?
There are a few things you can do to reduce your chances of limping around the house. Pick a pair of running shoes that cushions the heel and supports your foot. (I choose ones that have good arch support for my flat feet, too.) If you have poorly aligned heels or feet that roll inward, a custom orthotic can prevent stress to the tendon—and, might I add, prevent knee pain. Warming up before running, stretching the calf muscles, and gradually increasing running speed and distance can all prevent Achilles tendonitis.

Have any of you had Achilles tendonitis? How about any other running injuries?