Achilles Tendonitis is a pain in the Achilles tendon often where it attaches to the heel bone. In this video I discuss the reasons for Achilles tendonitis – calf problems, anaerobic excess, improper footwear – as well as treatments you may want to consider, including those you should avoid such as stretching and orthotics.
Natural Injury Treatment & Prevention for the Athlete Within
Thanks for posting. Took 3 days off recently and have been massaging my calves. Didn’t think they were even sore until I worked a few spots and found some really tender areas. Are shoes not an issue while it is healing or is it better to only run in shoes that don’t irritate the area until it gets better? Does the bursa get inflamed or the side of the tendon where it attaches? Just curious. Thanks again for the article.
After you have a spur (or the pump bump) in the area, yes you may have to stay out of certain footwear for a while if you keep irritating the inflamed area. Either the bursa, or the tendon, could be inflamed, or both. But if it’s the tendon, the thought is that it can’t really inflame as much as was once thought – so tendonitis isn’t the most accurate term. Again, as I mention, don’t concern yourself with exactly what is inflamed, if anything.
Thanks!
Thanks for the reply. Yeah nothing really hurts or is inflamed except for the little bump on the lateral side of my heel. Will the bump go away (I’m hoping so) or will the discomfort just go away with time? Also, what is the general time frame that something like this should take to resolve itself (obviously this depends on how much I’m running while I’m wanting it to heal)?
It might go 100% away or at least come down enough so it doesn’t bother you- just like the one I have and show on the video. If you find the trigger points in the calf and are able to get to the cause, they can resolve quickly – days, not weeks. Different for everybody though.
This isn’t directly on topic (achilles) but it is calf/shin related. My daughter was a track runner but had to give it up due to persistent shin splints and/or stress fractures in her legs. She was prescribed orthotics ( I know, bad move). She has recently expressed an interest in trying to return to running. To get started again, I’m assuming the first thing to do would be to get rid of the orthotics, correct? After that, I am not sure as to what would be the best plan to get started again without risking re-injury. Any thoughts? I liked your idea of working with bare feet on a towel or sheet to build up foot strength. Thanks for all the very helpful information you post here.
Mitch
Hi Mitch, thanks for the nice comment. My post on shin splints is here. The shin splint video will be up sometime next week. Yes, you need to get her feet strong and that will not happen with orthotics or wearing thick-heeled shoes or any motion-control shoes. The more minimalist the better. May have to slowly ease into them over time. Also check out the advice I have on aerobic training and heart rate monitor use under the Training tab. The more aerobic she is, the less chance of any injury, shin splints included.
Thank you for the reply. This is excellent info and I will pass it along. I will keep you posted on her progress. Again, many thanks. Mitch
I was just diagnosed with posterior calcaneal enthescopathy. I have a heel spur and pump bump, it’s tendor to the touch. I have not run in over 2 weeks (it’s even painful to walk) and this has not gotten any better. What is the typical time frame until I feel better and can start running again? Also, I have been SLOWLY transitioning to more minimal running shoes but my podiatrist said that I may need to go back to a higher heeled running shoe due to this injury and my high arches (plus I’m a recovering plantar fasciitis sufferer). Any suggestions on what type of running shoe I should use once I can get running again?
Hey Beth – so you got the diagnosis of the bony attachment rather than the tendon inflammation dx, either way, as I say in the video, call it what you like – the diagnosis isn’t important – why you got where you are is. You still need to feel around those calf muscles and see if there are any trigger points and take care of them. I don’t agree with your podiatrist; they have not basis for recommendations of more supportive or cushioned shoes and it doesn’t matter whether you have high arches or flat feet. The calf muscles, especially the soleus, is a highly anaerobic muscle, and since you have had plantar fasciitis, it’s almost a guarantee you’re too anaerobic. Read here. How quickly you recover depends significantly on how deep you are in the anaerobic lifestyle.
Thank you for the reply. It does make sense that I have been training anaerobically after I have read your articles. Definitely something to fix when I can get running again. Any guestimate on when I can start slowly running? Do I just wait for the swelling and pain to go completely away? On average how long should that take? Are we talking days, weeks or months? Thank you for all the information on your webiste, I’m thrilled to have stumbled upon this from Miss Zippy’s blog!
You’re welcome. I’d love to give you some time frame, but that’s impossible. It’d be a guess since I know so very little about you. Some people can recover in a week, some a month, some unfortunately never recover because they don’t fix the cause. As you know from Miss Zippy, and this post here, I helped her get over her painful ITBS in just over one day. So it depends on if you trace down where the problem is coming from, and help the body to reset itself, in a way. So if you’re doing the correct therapies, wearing minimalist shoes, NOT stretching, training aerobically, and eating well, then definitely days, but many athletes don’t get all those things going correctly so they end up injured a lot longer.
Sock Doc,
I am beginning to believe that I have suffered for years with what you discribed above. You may know my friend Dr. Mark Cuccuzella. For the past 2 years I have learned a lot from him about proper running technique, training and foot wear. Even though I have made dramatic changes, I still have pain in my heel and calf. I am 25 years old and I train at 160 HR. Do you think I need to bring that down to 155 when the pain gets bad? I have used foam rollers, “the stick” and stretching to relieve the pain, but as I am learning stretching is not what to do. Do you think I should move towards a product more aggressive like Trigger Point Performance rollers?
Thanks, Jared
Hey Jared, thanks for the comment. If you’re injured then ideally you should be going with a HR of 180-Age-5. So that puts you at 150; and that also means your aerobic zone is 140-150 HR. So at 160 you’re very high, and still too high at 155. So I would drop it way down. Also, don’t just go lower HR when the pain gets bad – you can’t play “catch-up” like that. You have to train consistently aerobically, just like Dr. Cucuzzella, Maffetone, and I talk about.
I also don’t think it’s necessary to use another type of trigger point therapy, unless you’re not able to achieve what you’re trying to achieve with what you’ve got. I doubt this is the case, because The Stick is pretty effective at getting to those calf muscles with Achilles problems. And right – no stretching.
Hope that helps!
-SD
I’ve have left sided achillies pain for about 8 months now. It began with a calf strain when beginning running again and building up distance too quickly. I was fit from cycling so I mistakenly thought I could run 10km after a few weeks. Pain started to develop in the achillies and I have swelling about 2-3 cm above the insertion point to the calcaneous.
I’m gradually trying to build up running after about 6 weeks off and am running slowly 2-3km every day barefoot on grass, with periods of walking during the runs. I find that massaging the swelling area with my foot in hot water helps to reduce pain and swelling, massaging the calves works as well.
As far has heart rate goes it is always quite high compared to anyone else I exercise with (I’m 42). With very light slow running (6 min/km) my HR is usually about 150, I can easilly still get it up to 195.
Do you have any tips or other things I could be doing to promote healing or reduction in swelling of the achillies.
Thanks
Chris
Hi Chris, yes, sounds like a classic case of Achilles tendonitis. Sounds like you’re doing the right things but I wonder what you’re missing because 8 months is way too long to still be injured, unless you were doing some other therapies and just recently switched over to the ones I recommended. Perhaps your diet is not quite right? Too high caffeine or refined sugars will delay healing, so will too many omega 6 vegetable fats and any amount of partially hydrogenated fats. Lack of protein will too – shoot for at least 1.5 grams of protein per kg bodyweight when you’re injured and training hard; maybe even closer to 2g/kg.
Yes, that’s a high HR so perhaps the 180-age formula is not for you. You can use Option 2 method that I discuss here – this way you can find your LT and get your zones to make sure you’re training aerobically. However – one problem – right now you’re injured, so you’re not going to get an accurate result from the run test. So my suggestion is you do a bike test and add on 5 to that number to get your run LT.
Thanks for the quick reply.
I ran normal amounts for the first 5 months and iced and did heel drops without much effect. Then went for acupuncture which really began the healing process. My HR on the bike and swimming is still very high compared to other people and the usual HR formulas I just ignore, my max is about 205. The only person I know with the same HR is my brother.
I’ve been doing the treatment similar to the ones you recommend for about 3 weeks and have really noticed the improvement. I do probably have too much sugar (chocolate), a moderate amount of caffeine and do get plenty of protein.
Sounds like you have a genetically high HR, so more reason to find your lactate threshold via the 30-min test rather than using the 180-age. Glad to hear the treatment I recommended is working for you. Do a week 100% sugar-free and see if you feel better – not just your injury but overall.
Hey Sock Doc
Have been sugar free for 4 days now and have decided to do it for 2 weeks. Its going pretty well, I almost lost it after about 24hrs. Was just hanging out for a sugar/chocolate fix. Rode that one out by having a beer or two instead. Since then its not really been too difficult, my wife is doing the same experiment as well so we can enchourage each other not to crack.
I haven’t really noticed much change yet but will keep it up.
If you almost “lost it” then you’ve got some sugar addiction and you’re fueling that with sugar alcohol. Not a good idea. Sorry to burst your bubble, but you’ve got to give it all up 100% – alcohol included – if you want to see the benefits. Stick it out through the first few days of climbing the walls wishing you had your sugar fix.
Hi Sock Doc,
I managed to watch your video – many thanks! It reminded me what I should be doing – and reinforced my opinion that stretching makes my injury worse.
I started calf massage a couple of days ago, and my leg is extremely tender where you showed (in the middle of my calf) It also feels stiff in the mornings, which I read is a sign of tendonitis.
Do you think I am ok to do a little run training as long my tendon isn’t hurting?
You should be fine to run as long as you don’t exacerbate the pain. Make sure you check out the post on tendonitis here, – nutritional support is a must. Good luck!
Thanks for your quick reply – and happy New Year!
I ran for 20 mins yesterday and also went out for a walk and its no worse today (still no tendon pain but still tight calf) so I will slowly start to increase my run volume again. I feel like I have wasted a lot of training time unnecessarily resting!
I have suffered with trigger points in my calves before, am I ever likely to get rid of them for good? And is it ok to continue training with them?
I was reading some of your other articles and was wondering if I should be running in different shoes. I usually do most of my training in Asics which are very soft and wondered if it is really necessary. I read that it can cause tendonitis and other ailments and am considering ditching them and training in ‘tempo’ type ones with less support and a thinner sole. Would you support this idea?
Thanks for your help
Yeah a lot of people waste time resting. You can get rid of those trigger points in the calves if you really monitor and deal with all the stress to those calf muscles – that means footwear, diet, training, etc. It’s okay to train on them if you’re training properly.
Asics suck. Could I be more direct? Nope. So back to your original question about getting rid of your calf pain for good. Not if you stay in soft Asics. Work your way into minimalist shoes. I think NB Minimus Road shoes are a great transitional shoe (then into their more minimalist Trail Minimus shoes which are great for the road too). Nike Free 3.0 is a good transition shoe too. Check out the banner on the SD home page for Two River Treads where you can get free shipping and 10% off with the SockDoc code.
Thanks again. My friends (who have been involved in running and triathlon longer than me) have all told me the same thing but I have been staying with them out of loyalty really. I usually race in Adidas but I will look at the shoes you mentioned. I am not sure how easy they will be to get in Czech.
Its like a breath of fresh air to be able to talk to a doctor who is actually interested in sports injuries. I have one more question about compression. I have calf guards which I sometimes wear after heavy training and racing and wondered what your opinion is on this. Do you think that wearing them dcould also help?
Thanks Matthew. By calf guards do you mean compression socks? If yes I don’t think they provide much benefit.
This video shows exactly the injury I have been wrestling with for the last 5-6 months. It’s my right Achilles tendon. I now have a nice bump on my heel. I was doing way too much racing and intense workouts. I treated it initially with ice, cut back in training and vitamin I (advil). Through the miracle of the internet I discovered a site in New Zealand that demonstrated how to find trigger points and how to treat them. Needless to say it was almost instant relief. I used a tennis ball to treat the solus TP and a golf ball for the bottom of my foot. I noticed a small, what feels like a TP on the bottom of my heel. Working it with th golf ball also provides relief. Can that be a TP also?
I was wearing Merrell trail sleeve shoes during all this anaerobic training but I had to go back to my Brooks trainers (thicker heel) to get some relief for the Achilles. The pain comes and goes now and it’s a lot less intense so I think it’s getting better slowly. I’m starting to transition back to a more zero drop shoe (Newtons) and have been following Dr Maffeton’s aerobic training/lifestyle methods.
Does the bump ever go away or will I always be prone to this kind of injury. Thanks for all the info you provide. It real helps us old guys keep running.
Jim
Great to hear you’re doing better Jim. The bump may never go away 100% if you’ve had it long enough for it to calcify. The one on my right Achilles is here to stay, but it never bothers me anymore.
What treatment would you recommend? My injury has progressed to the following steady state
1. In the am heel is a little tender but feels ok after 1-2 steps.
2.Go for an easy 30-45 min run aerobic heart rate < 118 bpm no pain at all during run 6 days/wk
3. Cool down walk for 3/4 mile no pain
4. Check for trigger point in calf and massage with tennis ball if necessary
5. Proceed with the rest of the days activities
6. Here is where it get's interesting, some days there is no pain the rest of the day but other days as the day progresses, the pain intensifies.
This has been the pattern for the last 3 months. The no pain/pain ratio is about 2/5. I'm on a plateau and am trying to figure out what to do next.
Any suggestions?
Exercise pattern shouldn’t be an issue there,Jim, based off what you have here. Maybe look at your footwear (what are you running in?), diet (inflammation), and lifestyle stress – these all can cause adrenal gland issues related to AT problems.
SD
Thanks for the quick reply. This whole fiasco started about 7 mo ago when after taking a Chi running workshop with Danny Dryer, I was trying to transition to Merrell Trail sleeves. See my comments above. After that and discovering that I could get relief with the trigger point treatment I found that returning to the Brooks (been wearing this brand since Bill Rogers promoted them in the ’70s) was less strain on the injured heel.
I am retired and lead a low stress lifestyle with a one man Tutoring business. Very little processed foods and sugar. I follow Dr Maffetones guidelines for fats balance and diet in general.. Spend as much time barefoot around the house as possible. The last few days when pain is present I’ve taken one 325mg aspirin and that helps a lot. I’ve been running for almost 40yrs and never had to take any time off due to injury but I’m considering stopping running for say two weeks and keeping up the aspirin treatment, assuming it’s bursitis and the inflammation just won’t subside with my current schedule. Do you think that’s worth a try? I really don’t have a clue as to the cause so I’m just throwing darts… What do you think?
Hi Jim, I can tell you one thing for sure, and you perhaps know this from reading Dr. Maffetone’s info on fats. If you ever feel better from taking any NSAID, including an aspirin, then your fats are out of balance. So I’d say with certainty that you at least are dealing with that since you say it helps a lot. Sock Doc guidelines for fats: eat a lot of egg yolks, coconut milk & oil, butter, avocado, olive oil and maybe fish oil. Grass fed red meat too. Never any vege oils – including canola. And easy on the nuts & seeds. If you’re already doing that and have been for at least 3 weeks, then maybe a nutrient deficiency.
My issue sounds like Achilles tendonitis from watching your video. My problem is trying to identify what the cause was. My mileage did not increase more than 10% between the weeks of my injury, but the intensity did pick up a little. At the same time I was attempting to transition into the Brooks Pure Flow from the Brooks Defiance. I’m unsure if the cause was a combination of both or the transition between shoes. I love the Pure Flows for their low heel to toe drop and quick turnover and do not want to go back to the defiance.
Combo could have done it. Pure Flow shoes might not work for you.
You hit the nail on the head. About 6-7 months ago I started snacking on a mixture of raw cashews, pecans and walnuts and the snacking had progressed to probably something closer to a full meal when totaled for the day. When I read your last response it clicked. So I stopped the aspirin and the nuts and the next day the cycle repeated but much less intensity and now after five days NO PAIN in the evenings at all. I still continue to run every day also. So I guess chronic achilles issue was driven by a fat imbalance.
Thanks for all your help with this. I really appreciate it and I may have learned something in the process. I owe you one.
Jim Stanton
Awesome to hear Jim. Glad to help. Thanks for that follow-up comment.
I am starting to change my mind when it comes to stretching. I first came across your advice from a youtubevideo on Achilles Tendonitis. I have been suffering with an achilles problem since this past September. I have read a lot of information on the subject, but I have not really healed much. I guess I am stubborn like most active people so I blame myself for trying to push through this injury. But I also know there is a lot of disinfo about AT injuries and how to recover from them. I guess I am posting my comment here because it has do with stretching. About 95% or higher of the info on regimens for recovering from an Achilles injury has stretching at the forefront of the recovery process. I don’t think it is helping me. As a matter of fact I think I am at the point where it feels the same majority of the time. I am no longer doing eccentric heel drops off a step or on flat ground. No longer stretching my calf and soleus muscles. No longer jogging lightly even though the tendon does not bother me on super short runs. After a short run my tendon feels a little tighter than normal and feels slightly tighter when I take the first step out of bed the following morning. I am currently on my second pair of new balance minimus trail shoes. I want to try to heal with a shoe that feels like walking bare because of your advice. I know a lot of books and web sites recommend cross training like cycling, but I don’t think it is helping me. I tried the exercise bike the last month and got little relief. Prior to that I was doing all the things for the tendon that is pretty much considered the norm. Massaging, icing, heating, stretching, and cross training.I am no longer messing with the actual tendon. I heard that using a heating pad on my calf is better than putting heat directly on the tendon. I am also convinced it is not an inflammation issues like most people say it is. I had a question about insertional Achilles injuries. In your AT video on youtube you mentioned using a stick or rolling pin to find hot spots, does that work for different tendon issues? Or are all tendon problems fixed by fixing the hot spots in the calf and soleus with the roller? My tendon is sore at the the insertion point. Another question I have has to do with walking, do you think walking with a tendon problem will help it? I don’t even know if walking for exercise is helping me at this point. I had another question about what I have read on most info for the tendon, lots of people advise to jump right back into running if the pain is not felt while running, even if the tendon is sore when you lightly pinch or touch it. What do you think about that? They also advise to strengthen the tendon by doing calf raises and eccentric heel drops when the tendon is in a healed state. Is there any place for Achilles strengthening after you have recovered from an Achilles injury? I would figure that running and walking would naturally strengthen it. Thanks for your time Sock Dock!
Hi Randolph, Yeah, well anyone who even just has read a little bit on the SockDoc site knows I pretty much think stretching (static) is the worst thing you can do, and “dynamic” stretching is a silly term because we should all just be moving naturally every day and in essence, we’re always naturally stretching. People will hold onto stretching for a long time even though it does more harm than good; (actually more harm than doing nothing). I don’t use ice. I don’t use heat. I don’t stretch – and I get people running pretty quickly again from their chronic injuries – meaning 1-2 days – almost always. So that’s why I think those conventional methods don’t work. Who has ever stretched, iced, or used heat and resolved their chronic problem in a day or so? I don’t think anyone.
With The Stick – I would stay off your Achilles Tendon – look more in the calf. As with most injuries, as I say in the videos, you almost never want to treat exactly where the pain is felt. Stay off it – and look for trigger points elsewhere. Check out this short post we just put up at NRC http://naturalrunningcenter.com/2012/02/11/experts-pros-cons-trigger-point-therapy/.
Yeah, walking is usually fine and I also think it’s usually okay to run if you have no pain. (usually – not always) And no on the calf raises – if the tendon is injured you can NOT strengthen any muscle or tendon by exercising it. It’s neurologically inhibited – that means your body has created a weakness there. Exercise will NEVER resolve a neurological weakness, just like stretching will never resolve a neurological over-facilitation (tight muscle).
If you can’t get it fixed, I’d be happy to find the time to help you out.
SD
Thanks for the info Sock Dock! I appreciate your time and I really like how simple your solutions are. I tend to think that simple solutions are usually the best answer to many problems. How often do you recommend the trigger point therapy? I have also read that micro tears can be caused by running even if you are not feeling any pain due to the tendon being warm. Do you have any info on that matter? What causes the majority of my concern is the soreness of the tendon. When you help people, how long does it usually take for the soreness to go away? Do you every recommend complete rest till the AT is completely healed? I would sacrifice my current fitness level to heal properly. I also wanted to let you know around the time I got my injury I switched from new balance minimus to saucony perergrines. The peregrines are considered to be minimal but not as minimal as my mt10′s, I am thinking that affected me in a negative way. And Before that I had got a pair of asics speedstar 5′s for road running, they are a semi minimal shoe. I am thinking that either the saucony or asics somehow affected my tendon. I agree with what you say about diet and stress playing a big role when it comes to the AT and other vital things. I am trying to improve on both. I am going to try running again this week. I will you let you know how it goes. Thanks for the invitation to help me. I am assuming you are offering to help me in person but I live In New Mexico. What state are you in Sock-Dock? One last thing, do you think I should run on a soft surface for awhile, I am thinking grass or hard packed dirt. I love hilly trail runs but I am afraid of causing more damage to my tendon.
Thanks for your time Doc! Thanks for the link to the article I will check it out!
I typically only have to treat the trigger point 1-2 times as I’m dealing with the actual problem (if it’s not from the trigger point) – as discussed on the NRC link. When I see someone I shoot for at least an 80% improvement on day one. Usually it is much higher than that. Rarely do I recommend rest.
Yeah, sometime the change in shoes can do it. I use the NB Min Trail and love them. I wouldn’t recommend you run on a soft surface – typically bad for gait.
I’m in NC – a bit more on my practice and be found under the About tab and Contact too.
Thanks for the info Doc. I read your entire “about” section and thoroughly enjoyed it. I agree with you on a lot of things. I have one last question, you mentioned in your AT vid that you had an AT issue a few years back. Can you tell me a little bit more about your experience with AT.
Again, I am quite grateful for your time and help.
Randolph
I had slight AT 20 years ago when I was training too hard/too much and not eating well (a low fat, high carb diet). That’s why I still have a bit of a “pump bump” today, but no problems with it.
You’re welcome for the help!
Great video and very helpful.
I wonder if I can give a little history re. my particular heel problem.
I am 57 and have been running and racing in the UK for about 13 years. I had been troubled with pain in my left heel at the achilles insertion point off and on for a little while but still managed to train and race. I decided about 7-8 months ago to switch to minimalist footwear and run a bit more mid to forefoot, I don’t think I was a heavy heel striker anyway. I bought some Newton shoes and some Inov8 Road-X 233 and slowly introduced them into my training regime and after 3 months i could run up to 7 miles at a time comfortably. The heel pain seemed to go away.
I did a few 5k races and a 5mile race towards the end of last summer and after the 5 mile in mid August my calf muscles were extremely sore, it being a pretty hilly course. Since then I have had, at times crippling pain in my left heel and back in Setember/October last year I was even having difficulty walking. I had a few rest periods of up to a month and carefully increased my training again back up to about 7 mile runs. However, the heel pain just doesn’t seem to go away. I missed all the winter cross country races except the last one in Mid February and ran ok but again I was very sore in my calfs afterwards. I saw a physio about 5 weeks ago and I was given a set of rules to adhere to – not to run on consecutive days, no hill running, no fast running. Also, to do eccentric heel exercises twice a day and to ice it afterwards.
I’ve done all this but still have heel pain and I can only run slowly for about 2 miles every other day.
Very frustrating! I am now looking for trigger points in my calf and trying to deal with them.
My question is – should I rest totally for while to let my heel calm down?
Is there anything else I should be doing? shall I drop the eccentric exercises?
Any help appreciated.
I assume by heel pain you’re having the same type of heel pain that you had 7-8 months ago and it’s not something like plantar fasciitis. But in a way it doesn’t matter too much because AT and PF are so closely related. Either one is from some type of excess stress (or stresses). So you look at diet, lifestyle (new job, family commitments), training (anaerobic?), etc. But also look at footwear. I think Newton is a company with a great philosophy but I often get asked why I don’t wear them or recommend them. There’s a reason why I don’t; I see too many problems with them over other “barefoot-type” footwear. I don’t like saying that because I wish I could recommend them more. I see them cause gait imbalances in patients and of course that’s not good. My best guess is that there’s too much “stuff” between the foot and the ground and they alter proprioception. So my advice to you is to try some new shoes. You’re in the UK – go get some Vivobarefoot. I don’t get paid one penny by Vivobarefoot, but I recommend them because I think they’re the idea shoe you can wear. And those exercises – I never have patients do them.
Let me know how it goes.
Thanks for your response. I’m not really aware of any stress in my life – work is not stress full, family life is fine. I haven’t been able to train anaerobically for some time now when running, but I do cycle a fair amount maybe some of that is anaerobic (specially that killer of a hill just before I get to work!) I will try dropping the Newtons for a while and I have already stopped the exercises for the last week or so. The pain in my heel isn’t as bad as about 6-7 months ago I just know that I can’t stress it too much. OK, I might just try some Vivobarefoot and will run more in my Inov8s aswell.
I’ll let you how things are.
Jeff,
Been there done that, as they say. I’m about a year ahead of you in terms of injuries and issues related to running. I’m 73 and decided to get back to “Natural Running” about 3 years ago. I’ve suffered a series of overuse injuries of which the Achilles (heel pain) was the toughest to get through. I won’t bore you with a lot of details but the sequence I went through is
1. Realizing that you have to do 90-95% of your training aerobically at a heart rate <180-your age this meant, for me, running as slow a 14:00 min/mile I used to "train" at 9-9:40
2. Tending to trigger points in the solus muscle on a daily basis
3. going barefoot as much as possible and doing drills to strengthen the foot and calf muscles
4. Core strengthening and balance exercises
5. Eliminate any mileage targets and cut runs to 1-3 aerobic miles and doing a Maximum Aerobic Function Test about once a month to measure progress
6. Make sure your nutrition is not the cause of the inflamed AT (google "Inflammation Factor") There is a really nice iPhone app for easily tracking what you eat to see if it promoting inflammation
I've been at it for some time now but it's starting to pay off. Running is enjoyable again, I'm running 5-6 days a week and the dreaded heel pain has finally gone away. I think the dietary changes finally did it.
The Soc Doc has been extremely helpful through a lot of this process.
God luck and keep at it.
Jim Stanton
Hi Jim
Well thanks for your interest. Got up early this morning and decided to try running but changed my mind. I was doing some light jogging on the spott warm up , and it was just a bit achy. So got my bike stuff on and went for a 10 mile bike ride in the rain. It was not that pleasant as it was a bit cold., but you have to do something.
Think I will have to get back to basics with a slow aerobic build up. Even up to about 3-4 weeks ago I was doing 5-7 miles every other day at about 7 min 45 sec per mile pace with only some discomfort. The problem just stays there though, I don’t dare go up steep hills or increase the pace any faster.
Shoulder surgery has knocked me back a bit but given me time to work out what to do next. I would be interested to know what sort of foot and calf strengthening exercises you did.
I’ve always had a problem with my left calf getting very tight, especially after tempo runs and races, it must be where the problem lies I think.
Glad to hear you have your problem sorted, hopefully I will catch up soon.
Regards.
Jeff you should look into having a deep tissue specialist look into the shoulder that you had surgery on, especially if it’s on the opposite side of the foot/ankle problem. As I mention in the videos and other places, past injuries are often a major reason for a current injury, or one not resolving as it should.
Thanks again for your response and comments.
The shoulder problem is on the left so it’s the same side as the problem in my left heel. I had problems in heel well before having surgery on the shoulder although the injury to that shoulder occurred about a year ago. Could be something worth looking into though.
Unfortunately because of a complication in my operation I am faced with having another op after I have recooperated from this one. So it looks like I will have another enforced rest from training in the near future.
Yes – you don’t just all of a sudden need surgery, unless you had trauma (accident). So you have to look back to when the pain started in the shoulder and then sometimes weeks, months, or even years before that a problem could have easily been developing in that area. Now, even though it’s on the same side, it could be affecting your ankle, and your ankle affecting your shoulder, regardless of the surgery complication.
Thanks for the response.
Well I find it interesting that shoulders can have such an intimate relationship with heels but it makes sense I guess.
Don’t want to bore you with all the details too much, but I have a confession – my left heel has quite a history and so does my shoulder.
The left achilles was injured about 7-8 years ago whilst doing some sprinting in a club training session, I was on crutches for about 3 days because it was painful to put my foot on the ground. At the insertion point some fibres had pulled off the bone. It took about 7-8 months to heel up and get back to some serious running again. The pain I experienced then is very similar to the pain I have now, although not as severe.
The shoulder was injured initially 2.5 years ago in an accident I had on the way to work. I was cycling and I collided with side of a Van, the left shoulder took most of the impact, nothing broken but very sore though. A year ago I injured the shoulder again lifting something far too heavy for me, ripping my bicep muscle and long head tendon, it didn’t heal very well, hence the surgery.
So there you are , at the moment I’m a bit of a mess! heel knackered, shoulder in partial recovery and to top it all my lower back has been playing up because of the strain of opening and closing the car door with my right hand when my arm was in a sling.
Neverless, I am positive, and determined to get back to health & fitness.
By watching your video I believe I have Achillies Tendonitis due to increacing my milage way too much way too soon. I have been running 100% barefoot since November and VFF’s or Merrell tough gloves otherwise. Totally no supportive shoes. I found a trigger point at the top of my calf on the outside almost to my knee. It was strange I never felt anything there before but when I work that area with a roller or my fingers it’s very sensitive and for a while afterwards it along with the achillies actually feels worse. Iver been doing it for 2 days 2-3 times a day. Is this correct and what should I expect. I haven’t run in 10 days and it’s killing me to stay off the trails. i’m going to the Boston Barefoot Running Festival this weekend and hope to be able to run. Thank You in advance for your help.
Well it sounds like you’re on the right spot but DO NOT work the trigger points so much. If any trigger point isn’t going away after you work it out a few times (a few meaning maybe 5 max), then you’re not addressing the problem. You’re just irritating it. I’ll have more info on this in a week I hope and it’s also being mentioned in a new video on The Knee – coming out next week or early the week after. This would be one of the very few times I might say that some ice over that trigger point may help to calm it down some. See if it works; if not then don’t keep doing it.
I would just like to ask a question about bare foot walking and running. I have decided to have a complete rest from running for about 6-8 weeks to try to clear up my achilles problem. In the meantime to help matters I am doing as much sock walking as possible at home and at work. I tried walking on asphalt a couple of days ago in barefeet and it was pretty painful but I managed about 300 metres. My question is this – How long before I can expect a decent pad to form on the soles of my feet? I have watched videos of Mark Cucuzella running barefoot on the road – he makes it look easy! think it will take me years to get to that level!
From my experience it was around 4 months. But I’m sure that’s different for everybody. No need to be in pain, but there might be some discomfort as your feet become more sensitized.
OK well I can go down the Vivobarefoot shoes route anyway for now. Do you know offhand which is their best shoe for road running? and do you use them for road running?
I use the Aqua Lite for the road – see the review on this site. Evo a great shoe too.
Hi Sock Doc,
I’m a marketing exec in Colorado Springs who loves the trail running lifestyle here. I also appreciate great brands — and your Sock Doc brand is terrific. Thanks for all you do!
I’m 54 and have run the Pikes Peak Marathon several times. I belong to Matt Carpenter’s Incline Club for trail runners.
3 years ago I had a skiing accident that required MCL/meniscal surgery with a couple stitches. Since then, I’ve worked hard to maintain my running lifestyle. My times have even improved since pre-injury races.
But I seem to never overcome stiffness in my surgery-repaired leg. It seems to move around from my thigh to my calf in stiffness. I’ve tried target-point massages that make the stiffness go away, but only temporarily. My achilles tendon is stiff but at the top rather than the heel.
Can I do anything to overcome this stiffness once and for all?
Hi Karl, If general trigger point isn’t keeping the problem away and only helping temporarily that is because you are not addressing the root of those trigger points. Perhaps there is one muscle that is being left out – untreated – and then you “unwind” quickly and the trigger points that are treated quickly come right back. Diet plays a big part too since you could have an inflammatory condition from diet and medical knee problems are closely related to the adrenal glands (stress) as I mention in the most recent Knee Video.
Thank you! I’ll fix the diet (too many carbs) and look for the target point.
Hi Soc Doc,
Great material here on your site- thanks!
I have a question about low-drop shoes. I am a competitive ultrarunner and nordic skier and train about 750 hrs/year (average about 2 hrs/day with regular 5+ hr training sessions). This past fall I switched to a lower drop shoe (4mm) from a more “traditional” drop shoe of 11mm. I was transitioning from running to roller skiing at the time so my mileage in the low drop shoes was not significant last fall (about 30-40 miles per week until the snow came in mid-November and I skied exclusively). I have now transitioned from skiing to running in the last 4 weeks and ramped up my mileage to about 80-90 miles per week (12-14 hrs depending on how much vert) in the low drop shoes. Weekly vert has ranged from a low of 7,000 ft. to a high of about 20,000 ft. After the second week of mileage ramp I started to feel pain in my achilles at the insertion point on my heel. It progressed to a significant level of pain during running and then also in walking during the day, particularly after sitting for a while. I took a few days off, the pain subsided, and then went back to running and the pain returned. On a lark, I decided to switch back to the 11mm drop shoes and the pain went away entirely. To test this result, I have twice used the 4mm drop shoes on a 15km run and each time the achilles soreness returns- and I can shut it down by returning to the 11mm drop shoes (with two different 11 mm drop models from the same manufacturer (all shoes both 11mm and 4 mm drop are Salomon)). I have now run pain free in the 11mm drop shoes for a week, just as I was prior to switching to the lower drop model.
I am a natural fore-foot striker and thought that the 4mm drop shoes would be an easy transition and better for my gait (I have always thought that the higher drop shoes allowed for the heel to interfere with my natural running style). So it seems perplexing that I would have difficulty moving to the lower drop shoe. As a competitive Nordic skier, foot muscle strength is very important and typically well developed given the need to control very precise movements at high speeds on downhills. I also live in the Rocky Mountains and have fairly advanced downhill running technique (by necessity) and associated foot strength. I expect that foot muscle strength is not playing a role. Additionally calf muscles are also highly developed in Nordic skiers and in the “classic” technique (my specialty) the motion and power stroke is very similar to running.
I should be very grateful for any insight you might have about my situation. I would like to transition to the 4mm drop shoes as the advantages seem significant (more natural stride, better trail proprioception, and they are lighter) but the clear issue with my achilles is a barrier at the moment.
Thnaks,
Ro
Hey Ro, yes I like how you’re thinking here. You’re a great example of a highly trained athlete who is doing just fine in the traditional 11mm drop shoes but you realize that you can perform even better in less drop. You wouldn’t think the switch to a 4mm would affect you so much, but since it is, you need to change your plan. Try gradually easing into them – walk in the 4mm (don’t run in them), walk barefoot as much as you can; then eventually – maybe after 1-2 weeks – run in the 4mm drop shoes a short distance, not the 15K you’re doing. Go around 5K. If that’s too much, then go less. So you run say a 5K in them and then the next several days you’re back in the 11mm. Then another 5K in the 4mm. If that’s successful, then you go 4mm 5K run and then 2 days in the 11mm. Do that for a couple weeks and then alternate each day for another week or two. Then 2 days in the 4mm, 1 in the 11mm…eventually you’re all 4mm and then you start building up your distance next. Of course this is just a rough example but you get the idea.
The Achilles shortens big time when you’ve been in traditional shoes for so long. That’s just “natural.” No rush to get to 4mm. I remember going from 4mm to barefoot and my Achilles would be tender for a day or so, letting me know to back off a bit. You’re just going to way quick in the transition! Eventually when you’re all 4mm (which you will get to), you’ll have the same plan to get from 4mm to zero drop. If for some reason this plan does not work for you then you might want to try a different 4mm drop shoe; but I don’t think that is the problem.
Let me know how it goes.
SD
Hey Soc Doc,
Thanks for the quick response! I’ll put the 4mm drop into the rotation on the shorter days and slowly build up. Good to hear that you had a similar experience and that I will be able to make this transistion. I’ll keep you updated.
Best,
Ro
Well Sock Doc this is good advice and I think it is very relevant to me aswell. I have been resting now for about 4 weeks because I have the same problem that Roland has and walking in zero drop footwear or walking in socks just like you! at work and at home. My feet get a bit cold in this weather here in the UK but I persevere.
Anyway I have been trying to follow Lee Saxby’s training videos on the Vivobarefoot website and he starts off with walking and then talks about crouching and shows the classic crouch in a video- now my question is – in your opinion is a ‘crouch’ position a stretch? because it feels like that when I do it. And more to the point should I be doing it? to help me transition into barefoot style running.
I intend to carry on with another 4 weeks rest to try to heal up my achilles before returning to running, but do plenty of barefoot walking or at least zero footwear walking. I may also try your transition advice for Roland aswell when I return to running. Am I doing the right thing?
I am not familiar with Saxby’s crouch position – can you post it here so I can check it out. I’m thinking it’s a deep squat and natural movement which is perfectly fine. Even though you guys are having Achilles problems, let’s move this to the post Lose Your Shoes – when you reply – more appropriate; thanks.
Dear Doc. I’m from Argentina. I started to run in a natural way about 2 years ago, after 6 month I started to suffer pain in both achilles tendons. After reviewing some videos I realized that I was overstrading to much, I tried with shock waves, laser, cold, etc. Then I found your page and started with Trigger Point Therapy using “The Stick” after 7 month I still have some pain and I was wondering what else can I do to complement the Trigger Point Therapy, the exentric excercises maybe? could you help me?
Thanks and regards.
Diego Prado.
Don’t just use The Stick – also use your fingers deep in the calf muscles and even the bottom of your feet. But remember as I discuss that the calf muscles are closely related to your adrenal glands – those are your stress hormone glands. So think training too much? Training too hard? Inadequate rest? Too much stress? Poor diet? Etc…
Hi Sock Doc
Great video, great thinking, lots of answers. my situation is much like “Roland’s” as far as the transition to 4mm shoes and the resultant AT problems. I do get instant relief when i wear the high heeled shoes i ran in for years, however i continue to plug on in the 4mm drop shoes and experience pain. i have had deep tissue massage in my legs and they find no existing trigger points..where i differ from Roland (other than his exceptional athletic ability and intensity of his training!) is that i have developed the ‘bump” on my heel which gets incredibly irritated when i do switch back up to the high heeled shoes..the heel counters are like cement which is why i continue to run in the nike free. (less friction but more tension on the AT)
assuming my calf muscles are clear of trigger points, could the tension in my heel be originating from the bottom of my foot…arent there muscles in that area that could be constricted along with the fascia and would benefit from TP therapy/release just as the calf/upper leg would? could the pull or tension be originating from that end of the kinetic chain?
thank you again!
Sure the problem could be coming from anywhere including your foot but even your shoulder, low back, or pretty much anywhere in your body.