The achilles tendon is the tendon that attaches the calf muscle (the combination of the gastrocnemius muscle and the soleus muscle) to the heel bone (calcaneus).  It is one of the strongest tendons in the body and is required to do a lot of work, particularly during athletic activities.  There are many causes of achilles tendonitis and it is seen in people with all different foot types. Most often, the cause of achilles tendonitis can be linked to increasing activities over a short period of time, particularly increasing running, walking or hiking distances too quickly before the tendon can develop the strength and flexibility to adapt to the new activity.  This is called overuse achilles tendonitis.  Achilles tendonitis also happens frequently in runners who perform their training in sturdy training shoes with elevated heels (all running training shoes), and then do a race or fast training in a racing flat or spike, that often has little to no heel elevation.  This causes the achilles tendons to have to stretch up to an inch more than they were used to, due to the training shoe artificially elevating the heel.  Couple this with the fact that most races are also run at a faster pace then training and you now have 2 factors that will increase the likelihood of developing achilles tendonitis.  The same situation is seen in women who usually wear shoes with high heels and then attempt to wear a shoe with a lower heel.  The achilles tendon is placed under additional stress that it is not used to and it becomes inflamed.  Achilles tendonitis can affect any part of the tendon, but most commonly affects the tendon at its insertion on the heel bone or just a few centimeters above the insertion.  The achilles tendon and back of the heel bone can be irritated by shoes that rub on the back of the heel and this is considered traumatic achilles tendonitis, but sometimes is called a pump bump.  The pain and inflammation encountered in this situation will be relieved only be removing the cause of the inflammation, which is the shoes.  This can occur if the shoe is too short in heel to toe length, the shape of the heel counter (the rounded cup shaped part of the shoe that covers the back of the heel) doesn’t match the shape of the heel, or if there is too much motion of the heel bone during walking and activities which causes it to rub on the shoe.  This is often easily determined by looking in the inside of the heel counter of the shoe to see if the material has been worn away by the back of the heel bone.  This type of achilles tendonitis or Pump Bump (so called because of the rubbing of the back of the heel bone by dress pumps) responds well to wearing clogs or backless sandals which put no pressure on the area until the area heals. Once the area heals, the individual will need to have their shoes and boots professionally fitted to prevent this painful problem.

Tendonitis responds to PRICE. Protection, Rest, Ice, Compression, and Elevation.  Protection – protect the tendon from shoes that rub on it.  Rest – rest the tendon by not participating in the activities that caused the tendon to become inflamed until the signs of inflammation are gone. Ice – ice the area of inflammation for 6-10 minutes several times per day. Compression – compress the swollen part of the tendon with the use of an ACE (all cotton elastic ) wrap or ankle brace.  Elevation – elevate the tendon above the heart to help decrease the swelling.

Achilles tendonitis is a serious injury and should be treated immediately, since prolonged and untreated inflammation can cause the problem to become chronic and allow scar tissue to form within the tendon which decreases its flexibility and increases the chances of complete rupture (tearing away from the bone or tearing in 2 pieces).

In flexible foot types a footbed or an orthotic with a deep heel cup may eliminate some of the excessive motion of the heel bone which aggravates the tendon.

Calf and achilles strengthening exercises are showing promising results for resistant cases of achilles tendonitis.  The exercises consist of dropping the heels lower than the forefoot, which causes the achilles tendon to contract, but get longer at the same time. This type of muscle contraction is called an ECCENTRIC (the muscle gets longer while it is contracting) contraction. As the individual gets stronger, progressively more weight is added (hand held weights or barbells) to cause more of an achilles stretch and thus a greater eccentric contraction.

An athletic trainer, or physical therapist is an excellent resource for help with this treatment.