Achilles Tendon Pain While Running: Symptoms, Causes, & Treatment

What is Achilles tendinitis?

The Achilles tendon is a band of tissue that connects your back muscles to the back of the heel bone. Achilles tendinitis is the inflammation of the Achilles tendon. Runners are likely to get  Achilles tendonitis due to repetitive running that puts their tendons under stress, causing them to tighten and swell.

What Are the Symptoms of Achilles Tendon Pain in Runners?

Achilles tendon starts as mild pain at the back of your lower leg and increases when you engage in a sports activity such as running. Below are some of the symptoms of Achilles tendonitis:

Primary Symptoms.

Sharp pain near the heel. Pain is felt due to a lack of enough blood circulation in the Achilles tendon.

Stiffness. Repetitive running or staying in the same position for long hours can tighten your tendonsInflexible tendons cause Achilles tendon pain.

Swelling. Due to overuse, your tendon gets inflamed, therefore causing dull, sharp pain near the heel.

Other Symptoms.

You may experience Achilles pain in the morning when you take your first steps. In the morning, your tendons shift from the resting stage to movement, and this can irritate your tendons.

During a run, when you suddenly increase your speed or distance, you may experience Achilles tendon pain due to the pressure put on your tendons.

After running, the pressure hitting your Achilles tendon may lead to pain. Also, the fluid in your tendon may build up, leading to inflammation.

Uphill running forces you to push your body too hard, therefore stressing the Achilles tendon. This may lead to pain, swelling or stiffness.

Difference Between Achilles Tendinitis(acute) and Tendinosis (Chronic)

Achilles Tendinitis is the inflammation of the tendon due to overuse, while Tendinosis is non-inflammatory degeneration of the tendon.

Tendonitis, Acute, may take 3 or fewer days to recover from, while Chronic may take 3 and above months to recover from.

If you take a surgery option for Achilles tendinitis, there is a likelihood of recovery, but Tendinosis has no assurance.

Your healthcare provider may recommend rest and anti-inflammatory drugs to treat tendinitis. Physical therapy, exercise and surgery are the best treatment options for Tendinosis.

Secondary Symptoms.

Warmth may be felt in the area of treatment. You may feel the tenderness that originates from the injured tendon.

Redness

Due to inflamed tissues, you may find the area of treatment appearing red.

Thickening of the tendon.

The tendon may thicken due to inflammation of the muscles, ligaments or tissues around your Achilles tendon. 

Why Do Runners Develop Achilles Tendon Pain? Common Causes

As a runner, you are likely to develop Achilles tendon pain since your Achilles tendons get highly used when running. Below are other factors that can cause Achilles tendonitis:

Common Causes.

Overuse. Overuse causes repeated stress on your Achilles tendon with time. Sports activities such as running, jumping and cycling are highly likely to cause Achilles tendinitis.

Tight calf muscles. Tight calf muscles put pressure on your Achilles when running.

Sudden increase in mileage. Increasing your mileage too quickly stresses your Achilles due to fatigued calf muscles.

Improper footwear. Improper footwear can twist your Achilles while running or playing.

Training Errors.

Hill repeats. If you are a runner involved in excessive hill running, you are highly likely to get Tendinitis since excessive hill running puts too much pressure on the Achilles tendon.

Poor Warm Up.

A poor warm-up can hurt your tendons. Warm-up stretches make your muscles flexible and ready for the run. A warm-up routine may help work out effectively before a run.

Repetitive Stress.

An example of repetitive stress is running continuously without stress. Repeated stress puts pressure on your tendons and makes it harder for you to participate in sports activities.

You are at higher risk for Achilles tendinitis if you:

• Play sports that involve sudden stops and starts.
• Are an athlete
• Are 50 years and above. Achilles tendons weaken with age, putting you at high risk of injury.
• Are a dancer 
• Participate in sports activities 
• Are in a job that stresses your feet and ankles.

Biomechanical Factors.

You are likely to have Tendinitis if:

• Weak and tight calf muscles 
• Have flat arches. You have flat feet if you have no or little arch in the sole. 
• Have bone spurs. Bone spurs are extra growths of bone tissue outside your bones.
• Overpronation. Overpronation occurs when you have a walking style that abnormally flattens the arch of your feet.

How to Treat Achilles Tendon Pain from Running

There are non-surgical treatments for Achilles injury,  best for people who have heart disease. Below are some alternative therapies that can work for you:

Rest. Your doctor may recommend that you take a rest for 2 to 3 weeks after you have been diagnosed with Achilles tendinitis. Rest helps in the recovery process. If you have an Achilles rupture, the doctor may recommend immobilisation for 12 weeks and using crutches to keep weight off the foot.

Wrap a bandage around the heel area to reduce swelling. Compressive elastic bandages reduce inflammation and movement.

Ice therapy can also help in reducing swelling. Apply ice for 10 minutes on the injured area 3 times a day.

Elevate your foot for 15 minutes daily to reduce swelling. Elevate 3 times a day to also improve the circulation of blood, which promotes healing.

NSAIDS treatments such as Ibuprofen and anti-inflammatory creams help in relieving pain for a short term.

Eccentric heel drops are rehab exercises that help in strengthening the calf muscles. Eccentric strength exercises involve applying a load to the calf muscle while it elongates, a process known as eccentric contraction.

Foam rolling rehab exercises massage your muscles by relieving tightness and soreness.Foam rolling improves the flow of blood in the affected area.

Calf stretches focus on relieving tight calves, relieving pain and releasing tension. Before stretching, ensure to massage your calves, it helps relax your muscles and improve flexibility.

As a runner, you may need medical interventions such as physical therapy, orthotics and shock wave therapy to be able to return to your physical activities.

Physical therapy involves strengthening and stretching exercises to promote healing and strengthen your Achilles tendon.

Your physical therapist may recommend a shoe insert to elevate your heel and reduce strain on the tendon. A shoe insert is an orthotic device that provides cushion to reduce the amount of force exerted on your Achilles tendon.

Shock wave therapy reduces pain and promotes healing by using sound waves to stimulate the flow of blood in the affected area.

Ignoring symptoms can lead to a rupture and chronic discomfort in the future. Always seek medical intervention when you notice Achilles tendinitis symptoms.

Preventing Achilles Tendon Injuries in Runners

Strengthen the muscles in your calves, glutes, and core. The stronger the muscles, the less the pressure on your tendons when you run or play. Some of the strengthening exercises include lateral lunges and squats.

Dynamic warm-ups. Warm-up exercises prepare your body to run and also improve the flexibility of your muscles.

Choose shoes that provide firm arch support and cushion your heels to reduce tension in your tendons. Always avoid worn-out shoes and ensure your shoes are in good condition before exercise.

Observe the 10% rule by gradually increasing the duration and intensity of your training. You can jog for 5 to 10 minutes as a beginner and increase it to 30 minutes as your body adapts.

Cross-training helps in reducing pressure on the Achilles tendon. Include high-impact exercises and low-impact exercises in your routine. For example, you can jump and run on Monday, swim and cycle on Tuesday. Repeat the same sequence for the rest of the days for better results.

Avoiding running on hard and sloped surfaces may injure your tendons and lead to Achilles tendinopathy. Exercises that produce a similar impact as your running activity can help prevent Achilles pain. Instead of running, you can choose to swim, cycle or take cardiovascular exercises that don’t stress the Achilles tendon.

Read More: Top 10 Performance Tips to Run Stronger and Injury-Free.

When to See a Doctor for Achilles Pain

You need to see a doctor if you notice persistent pain in your Achilles Tendon. Some other reasons you may require to seek medical help include:

• If you notice a popping sound when you get an injury 
• If the injury doesn’t heal after rest 
• If the pain disrupts your normal activities, such as the inability to walk.
• Severe swelling 

The doctor may recommend X-rays and MRI scans to determine the root cause of the pain. X-rays and MRI scans create images of your muscles, ligaments, tendons and bones.

The MRI Scan uses a large magnet, computer and radio waves to create cross-sectional images of your Achilles tendon. It examines the injuries and abnormalities in your tendons.

A CT scan releases a series of narrow beams through the body, Data is transmitted to the computer to build 3d cross-sectional images of your Achilles.

If the doctor notes tears, severe inflammation, or broken bones, a specialist referral may help treat your Achilles tendon.

Mild injuries may not require serious treatment because they can heal with enough rest. However, if the pain persists for 1 to 2 weeks, seek medical attention immediately.

Can You Keep Running with Achilles Tendon Pain?

Running with Achilles tendon pain depends on its response to running. If you still find it difficult to run, it means that your previous running activity was intense, and you need to scale down.

You can start by reducing your mileage to assess the symptoms during and after. Try walking for 30 minutes first before running.

If you feel irritation in your tendon during and for 24 hours after a run, reduce your speed, distance, frequency and terrain. Steep inclines and uphill increases the stretch and compression loads on the Achilles tendon.

If you make the adjustments and your Achilles still hurts, stop running and seek medical help immediately.

Low-impact exercises such as swimming and cycling improve your cardiovascular health without adding pressure to the Achilles tendon. For cycling, do it for 15 minutes to monitor your symptoms. Increase cycling distances if the pain doesn’t accelerate.

Avoid pushing through pain. Pushing through pain weakens your Achilles to an extent that it cannot handle loads as before.

Assess your load capacity before your daily exercises to avoid long-term damage to the Achilles tendon.

How Long Does It Take to Recover from Achilles Tendonitis?

Recovery depends on the treatment plan and severity of the condition. Mild pain can heal within weeks through taking home remedies, or over-the-counter anti-inflammatory treatments. Severe injury requires physical therapy that may last for three months or even surgery.

Have enough rest to boost your recovery process and avoid activities that stress your Achilles, such as running or basketball games.

The Role of Footwear in Preventing Achilles Tendon Pain

Wear shoes with a higher heel-to-toe drop to reduce strain on your Achilles tendon. Running a higher heel-to-toe drop will reduce workload while running; therefore, you will feel less pain.

Worn-out shoes may not have adequate heel cushioning.

Physiotherapy exercises for Achilles tendinopathy

Weak tendons cannot handle too much workload, however, strengthening exercises, eccentric and concentric exercises, can help improve your tendons. Below are physiotherapy exercises for Achilles tendinopathy.

1. Eccentric calf exercise Part 1. Below is how you do the exercise to strengthen your calf muscle and treat Achilles tendinopathy.

• Stand on your toes on the edge of stair staircase
• Hold on to a strong handle for support 
• Lift one of your legs (left) off the step and go on your toes with the other one
• Place all your weight on the left leg
• Drop the heel downwards below the step level and repeat the same procedure to the right leg.

2. Calf Heel  Rise. This exercise strengthens your calf muscle and ankle joint.

• Holding on to the wall, stand upright with one leg 
• Gradually raise onto your toes
• Control the movement back down

3. Heel Drop Calf Stretch. This exercise stretches the area below the back of your knee.

• Stand on your toes on the edge of a stair.
• Drop your heels downward 
• You can support yourself if necessary 

Alternative Therapies for Achilles Tendon Pain Relief

Massage therapy improves blood circulation, reduces pain and also relieves tight calf muscles. Dry needling helps in the slow contraction and relaxation of the irritable muscles, and this helps your tendons to relax.

Laser therapy is recommended for chronic pain. It has anti-inflammatory effects on the inflamed tendons of the Achilles. Laser therapy promotes the natural healing process by improving blood circulation and increasing cellular repair functions. Laser therapy is pain-free. It is applied alongside physical exercises recommended by a physiotherapist.

What you eat affects the healing process of your tendons. The right diet supplies nutrients to your tissues to help with the healing process.

Dark leafy greens like broccoli, spinach, and kale are rich in antioxidants that fight stress that causes inflammation. They also contain vitamin C, vitamin D, vitamin K, magnesium, and vitamin A. Ensure that half of your plate has raw or well-cooked vegetables.

Bone broth contains collagen, which helps in the development and formation of tissues within your body. It speeds up recovery, so take it at least three times a week.

Foods rich in Vitamin C help in rebuilding collagen. Examples of vitamin C foods include: berries, lemon, oranges, pineapples and pepper. Proteins like raw dairy, eggs and lean protein repair broken tissues.

Spinach, beans, whole grain and beef contain zinc that helps in the development and repair of tissues. Also, foods like avocado, sweet potato and bananas are rich in potassium that help in relaxation, muscle recovery and blood circulation.

Achilles Tendon Pain vs. Other Running Injuries

Achilles tendon pain and any other running injuries affect runners or athletes, but they affect different areas and have different symptoms. Below is the difference between plantar fasciitis, calf strain and Achilles tendon pain symptoms.

 

Running Injury	Plantar fasciitis	Calf strains	Achilles tendon pain
Symptom	Plantar fasciitis feels like stabbing pain at the back of your foot close to the heel. You may feel pain when you make your first steps, and it may increase with more steps.	Calf muscles happen when your toes forcefully move upwards and your ankle quickly pulls your calf muscles down.	Achilles tendon pain and heel pain at the back of your leg when you run or walk.

 

Retrocalcaneal bursitis is pain at the lowest part of the heel, while Achilles pain is located above the heel.

Can stretching worsen Achilles tendon pain?

Yes, stretching can cause your injured Achilles tendon to feel worse. Injured tendons should not be stretched since it may delay the recovery process. Also, overstretching your tendons can cause Achilles tendinitis.

Calf stretches involve pressing your Achilles tendon against the heel bone, and this can be painful. If you sustain the stretches for a long time or stretch forcefully, you are likely to get insertional Achilles tendinosis.

Are there specific exercises to avoid with Achilles tendonitis?

Exercises that require you to run or walk may stress your Achilles tendon. Running or walking up steep inclines and hilly areas may cause Achilles tendinitis.

Is surgery ever needed for chronic Achilles tendon pain?

If other treatments don’t work, your healthcare provider may recommend surgery for Achilles tendinopathy. A surgery is recommended if you tore your tendon or have a ruptured Achilles tendon.

How does caffeine or dehydration affect Achilles tendon health?

Dehydration causes electrolyte imbalance, and this disrupts signals that influence how your muscles function and nerves signal. Dehydration leads to cramps, pain, inflammation and irritation of the Achilles tendon.

Avoid taking caffeine 6 hours before you sleep. Your Achilles needs enough rest to heal, which you can get from having enough sleep.

 

What’s the best sleeping position to reduce morning Achilles stiffness?

The best sleeping position to reduce morning Achilles pain is:

• Sleep on your back with your injured leg elevated to reduce swelling.
• Sleep on your side with the injured leg elevated.
• Avoid sleeping on your belly to prevent stiff calf muscles.

 

Can Achilles tendonitis lead to long-term damage if ignored?

• Achilles tendonitis can cause long-term damage if ignored. It can lead to complications such as:
• Permanent damage: Due to thickening, scarring and calcification, your tendon may get permanently impaired and fail to function.
• Chronic pain and discomfort. Persistent inflammation can lead to chronic pain and discomfort that interfere with your daily work activities.
• Inability to engage in physical activities. If left untreated, you may not manage to work out, and this can put your cardiovascular health at risk.
• Increased risk of rupture.
• Altered mobility. Persistent pain may change your walking and may cause musculoskeletal problems.
• Increased risk of injuries. An injured Achilles tendon alters your movement patterns, therefore increasing the risk of other overuse injuries such as Plantar fasciitis.