Tips from the Experts

By July we have exhausted the myriad of excuses as to why we haven’t fully returned to our summer activities and sports.

It’s at this point that we believe it’s necessary to simply throw ourselves back into the swing of things by pounding the pavement with running, hiking the steep mountain trails, or just returning to a more aggressive and lengthened aerobic walk. Invariable what seemingly happens out of nowhere is heel pain, sometimes severe heel pain.

By July we have exhausted the myriad of excuses as to why we haven’t fully returned to our summer activities and sports. It’s at this point that we believe it’s necessary to simply throw ourselves back into the swing of things by pounding the pavement with running, hiking the steep mountain trails, or just returning to a more aggressive and lengthened aerobic walk. Invariable what seemingly happens out of nowhere is heel pain, sometimes severe heel pain.

What is this and how could it happen when you took a couple of minutes to ease into your activity at a slower pace? It may be Achilles tendonitis due to inflammation or irritation of the Achilles tendon, the dense band of tissue running up the back of your lower leg attaching your calf to your heel.

It is rather common for Achilles tendonitis to result from sports that place an intense amount of stress on your calf muscle which is made up of the gastrocnemius and the soleus muscles. However, it is just as likely to begin when initiating a sudden increase in the frequency and intensity of any weight bearing activity, even walking. Structural problems may also be to blame like spurs or small tears.

In addition to general tenderness over your tendon, you may notice pain or a dull ache when pushing off of your foot while walking. This may lessens as your tendon warms up. You may especially note this in the morning while taking your first painful steps which then unexplainably resolve. That is until you again increase your activity later in the day.

Improper conditioning including poor flexibility and inadequate strength is typically the perfect recipe to develop a tendonitis when added to walking, running, jumping or pushing up on your toes. Flattened arches (excessive pronation or pes planus) may also be the predisposing factor. Sometimes even trauma to the tendon may be the cause. But it’s not unlikely that it is simply a matter of too much, too soon as you didn’t properly warm-up.

Although self treatment is available via rest, ice and medication (under your physicians advice), your best bet is prevention. Starting slow and increasing your activity level gradually is the first step. Warm-up via stretches that focus on your gastroc and soleus muscles along with your hamstrings. You can easily stretch your gastrocnemius by leaning forward against a wall with your hands. Leave the leg you are stretching back behind you, heel on the ground and knee straight. Your resting leg is the forward leg. Hold your gentle stretch for 10 – 30 seconds for 5 repetitions.

To stretch to soleus, the lower deeper muscle, maintain the previous position but bend the knee of the back stretching leg and lower your hips a bit. The hamstring stretch is best attained when lying on your back, resting leg bent, and stretching knee supported with your hands as you actively raise your foot to the ceiling. Feel the stretch down the back of the leg.

Strengthening of your calf muscle is equally important and can easily be accomplished by rising up onto your toes and slowly returning your heels to the ground. Perform this exercise in sets of 10 reps for 2-3 sets to begin. You can further advance the strengthening exercise by turning both heels in together or out apart for sets of 10 repetitions. Be sure to gradually increase day by day making sure you do not over-do-it.

Cross-training or training on multiple surfaces performing multiple various impact activities is a good idea as well. And of course, the educated choice of appropriate shoe wear is essential. Be sure to choose shoes that fit, provide adequate cushioning for your heel and have a firm arch support which will aide in minimizing tension on the Achilles tendon.

In the event you recognize the onset warning signs of Achilles tendonitis, be sure to rest, ice, compress, and elevate. If possible keep moving as it is essential that prolonged periods of inactivity be avoided. Be sure to move your foot and ankle through its full range of motion regularly and perform gentle stretches to remain flexible.

If you or someone you know suffers from heel and Achilles tendon pain, it is ill-advised to begin a new exercise program without consulting first with your Physician physical therapist, certified athletic trainer, physiatrist or other specialist who regularly treats foot and extremity pain. It is important to first get an accurate diagnosis for the cause of pain, as the specific exercises recommended will depend on the cause. Achilles Tendonitis, if left untreated, may become a much more serious condition that can lead to surgical intervention.