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Tuesday, July 20th, 2010

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Heel Ankle

The Runner's Heel: Achilles Tendonitis

Achilles was the Trojan war Hero made famous by Greek Mythology. He was dipped into the river Styx by his mother, in an attempt to protect him in battle and make him immortal. Unfortunately he was struck by an arrow in the one spot at the back of his heel that she missed when she dipped him in the magical river. The Achilles tendon, which connects the powerful calf muscle to the back of the heel, now bears his name. Runners, athletes and Achilles are all similar in the vulnerability in this area. Without this tendon (which happens to be the largest and strongest in the body) running, jumping and athletic activities would be severely hampered. Anyone can develop Achilles tendonitis. It is a common, but preventable (and treatable) overuse injury of the tendon.

If you are out running hills and feel a sharp pain or dull ache in the back of the leg down near the heel, this could be Achilles tendonitis. If you feel along the course of the tendon (where it is mobile just above your heel bone) and you have tenderness, this is most likely Achilles tendonitis. Don't ignore this. Ice the area and decrease your activity level. Avoid hills or speedwork until it subsides. If it doesn't quickly get better, see your podiatrist. Otherwise you might end up sidelined for four to six weeks.

One of the most effective ways to prevent injury to the Achilles tendon is through a good warm-up and stretching routine prior to long runs, hill repeats and speed workouts. This keeps the tendon pliable, preventing micro-tears. Stretching can improve blood flow, enabling a speedy recovery if you do become injured. Stretch after a short warm-up; you should avoid aggressive Achilles stretches when your muscles are cold.

Patients with Achilles tendinitis often report a sense of sluggishness in the leg, diffuse pain around the Achilles tendon, or mild pain either during or after exercise that usually worsens as they run. Other symptoms can be swelling, morning tenderness in the Achilles tendon, or stiffness at the back of the leg that generally diminishes as the tendon warms up with use.

The severity of the injury to the Achilles tendon will help determine the treatment. But in most cases, rest is part of the treatment. It might be necessary to stop running and other high impact exercise, although often you can cross-train and cycle, as long as there is no pain or stress to the healing tendon. Treatment can also include non-steroidal anti-inflammatory medication or orthoses, which are devices designed to help support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert.

Other treatments are bandages specifically designed to restrict motion of the tendon, stretching, physical therapy, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors that work against the Achilles tendon. If the tendonitis is mild, simple modifications of activities may help. Decreasing mileage, running on flats instead of hills, and backing off the activity level until there is no pain with exercise can allow the tendon to heal. In general, ice is much better than heat for tendonitis.

Some medications can increase the risk of Achilles tendon ruptures (complete tear). Whenever taking medications such as oral steroids or antibiotics (prednisone, Cipro, Levaquin, etc.) you should not exercise unless you have discussed this with your treating doctor. You may have seen in the news where the FDA recently posted a strong "Black Box" warning about these antibiotics and the associated risk of tendon ruptures.

A torn Achilles tendon is serious. Interestingly, it is not always painful. However, there is usually significant weakness and difficulty standing up on the toes if this has occurred. Any suspected torn tendon can be serious and should be evaluated by a podiatrist. In rare cases surgery may be needed to repair the tendon.

If you happen to be a marathon runner in training for battle on the course; warm up before you stretch, but most of all, don't deviate from your training program. Do not run through the pain if you think you have Achilles tendonitis. If you are a Trojan War hero in battle, and you see any arrows coming your way, stay low and keep moving!

About the Author

Dr. Christopher Segler is an award winning foot and ankle surgeon practicing at the Ankle & Foot Center of Chattanooga at http://www.anklecenter.com. He is also an Ironman Triathlete specializing in sports medicine and surgical treatment of elite athletes. If you would like to learn more about common causes of foot pain, you can order a FREE copy of his book, My Fit Feet, by calling toll free (888) 701-6099 or visit http://MyRunningDoc.com.

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