Sock Doc: Treatment & Prevention of Achilles Tendonitis

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.

Video Transcript

Hey. This is Sock Doc and today I’m going to talk about a common running injury called Achilles tendinitis. This is an injury that many people suffer from if they’re training hard, if they’re racing a lot. It’s a pain in the lower part of your leg, right where your Achilles tendon attaches to the heel of your bone. So your Achilles tendon is actually an extension of your two calf muscles, your gastrocnemius and your muscle, and they go down and form a tendon. Tendons attach muscles to bones and it’s called your Achilles tendon.

We’ll just get right to it. Your Achilles tendon is right here and many people will feel pain right where their Achilles tendon attaches to the calcaneus, their heel bone. Now you can see right there I have a very little bump that I had from when I had some Achilles tendinitis back in 1992 and 1993, when I was training hard in college. It’s the one time I actually got a cortisone shot right there in my heel bone and it basically calcified up. So to this day I still have a little bit of a bump.

Now some people might call that a heel spur and there’s actually a term called a pump bump, kind of a funny name, when that spur kind of flares up a little bit. There’s also a term called retrocalcaneal bursitis, which is when the bursa, which is underneath that Achilles tendon flares up and you have bursitis, another type of inflammation, -itis means inflammation, so inflammation of the bursa, tendinitis, inflammation of the tendon.

Many people say that the pump bump, that swelling on the outside, the lateral part of your Achilles is from scuffing against the back of a shoe or a walking shoe. I don’t agree with that at all. Typically you have the Achilles tendinitis or you have a calf issue resulting in a strain of the Achilles tendon, and then that flaring up, that inflammation of the Achilles causes you to approximate the distance between your heel and the shoe more, in other words you have less space, and that rubbing then creates that spur or the pump bump.

Here’s the important thing though. As I’ve talked about in the other videos it’s always more important to diagnose why you have a problem rather than what exactly you have. Whether you want to call this Achilles tendinitis, whether you want to call your pain a heel spur, a bone spur, retrocalcaneal bursitis, or a pump bump, ultimately it really doesn’t matter. Diagnosing what you have does very little, if anything, to fix the problem. So we’re going to diagnose why you have it and that’s the important thing, to hopefully prevent it from happening again and recover from this injury faster than you would otherwise.

One of the Sock Doc rules, as you know, is we don’t stretch any injuries. Stretching pulls muscle fibers away from one another and when you want to heal muscle fibers you want to approximate those back together. Even physical therapist today are starting to use methods such as scraping methods, very painful methods, when they go down the belly of a muscle and try to line those fibers up. And that’s now proven that lining those fibers up and approximating these fibers helps to heal injuries.

It’s actually, in my opinion, one of the most effective way you can heal an injury. And this is also known as trigger point therapy or origin insertion technique. So it’s very painful and I’m going to show you how to do that right now because the Achilles tendon is an extension, again, of your calf muscle. So we’re going to look for an injury here on the calf and you’re going to especially look right here, right where the meaty part of your calf muscle starts to narrow down and come to the more narrow part of your calf and then ultimately into your Achilles tendon. You’re going to look for tender spots, like right in there and push with your thumb.

See what’s tender, poke around. You can squeeze with your thumb and index finger too, down this soleus, the lower part of your calf, down to your Achilles here, and look for any tender spots. And if you find them either hold them or rub them out in a circular motion. They’re going to be very tender, very hot, compared to the other side that might not be injured and you can see what might really be painful. A lot of runners have tender calves anyway and sometimes it’s because there’s an injury that’s starting and you can possibly prevent it if you start to work those out.

So you’re going to work those out. Sometime they’ll wash away, we say, they sort of dissolve and feel better. And they might not, but they hopefully feel better the next day or even right now. If you work them out a little bit you might notice that as you walk or run more they don’t hurt as bad. Typically, as you may know, with Achilles tendinitis, if you have it, it hurts more when you walk or run up hill because of the plantarflexion aspect of using your calves while you’re doing that activity.

Another little device I like to use sometimes on people is the stick. You might have seen these at running stores or expos. They have these little movable beads in the middle and you hold it like this and then go up the back side of your leg so you’re working it up and down your calf like that, especially over, obviously, the tender area. I’m putting pressure towards my leg and my leg pressure towards the stick and you’re rolling that up and down. This is a nice little instrument to use for hamstring issues and calf issues where you can get right in there. So look for those injuries in the calf.

Second, remember, no stretching. And third, as usual, with any injury, as I’ve always said, no orthotics. Let’s get off those orthotics and those built up shoes. The more your foot can stay closer to the ground, the more you can walk barefoot, the more you can use minimalist shoes with a very low heel to forefoot drop, a wide toe box, and very little support or cushion, the more you’ll strengthen your feet and get over your injury quicker and prevent other injuries from hopefully occurring.

But there’s other reasons why injuries can occur just other than bad footwear and one of those reasons, again, as I’ve talked about before, is when you over train. Training at too high of a heart rate anaerobically, training too often, racing too often, or too high of stress levels which could even be from eating a poor diet, or from too much emotional stress like if you’re working too many hours, family stress, or any other mental stress you might have that’s basically too much that you can handle.

That tends to stress our bodies out and injuries result from that because there are certain links between stress levels in the body and cortisol levels, which are one of your stress hormones, like adrenaline, and these tend to provoke injuries in people. It happens basically from the way that they work with muscles, the relationship between your hormones and muscles. And I talk more about this on the Sock Doc website about eating better, about eating more appropriately, no hydrogenated fats, low sugar in your diet, and staying away from things like MSG, refined foods and monitoring stress levels, training aerobically rather than anaerobically, using heart rate monitors and that sort of thing.

So if your training properly, if you’re eating well, if your stress levels are in check, and you have the proper equipment, in this case, with a running injury, that usually just means footwear, and if your feet are strong from wearing the proper footwear, and not wearing orthotics and walking barefoot often, you’re going to probably never end up with an injury like Achilles tendinitis, or a pump bump, or a retrocalcaneal bursitis, or a heel spur, or a bone spur, whatever you want to call it, and your feet are going to feel very strong and you’re going to have strong calves and lower legs and great balance.

The other thing is, other than no stretching, no orthotics, is with the entire Sock Doc philosophy make sure you always stay off that injury, especially in the acute phase. It might be okay to ice it a little bit if you need to settle down the injury, if that makes it feel better, to cut down on some of the inflammation. But ultimately, to heal the injury, you need to look distant from the injury, as I’ve talked about in the other videos like plantar fasciitis and iliotibial band injuries. In this case, stay off your Achilles. Don’t be pushing around right where that Achilles inserts into your calcaneus, your heel bone. Go up towards the calf. You might even have to go all the way up towards where your calf actually comes over to the other side, behind your knee bone, the tendons of the calf muscles up here where it’s closer to your hamstring.

So focus on that area behind your leg, and not too much on the Achilles tendon area because often pushing on the Achilles and doing any strong techniques there, the trigger point therapy, or using the stick actually on your Achilles, will most likely just inflame it. You should be able to settle down a lot of it, hopefully all of it, by addressing the muscle further up. But don’t forget to address why you have the problem. And again, it might not be from the shoes. It could be from over training and those other aspects that quickly result in an injury. And that’s how you’ll go about getting over this injury much faster than anybody has every told you and hopefully preventing your Achilles tendinitis from happening again. I hope you enjoyed this. Thanks.

Comments

  1. 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.

  2. 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

  3. 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.

  4. 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

  5. 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.

  6. Matthew from Brno says:

    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!

  7. Matthew from Brno says:

    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.

  8. Matthew from Brno says:

    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?

  9. Jim Stanton says:

    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.

      • Jim Stanton says:

        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

        • Jim Stanton says:

          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.

  10. Gerald Currie says:

    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.

  11. Jim Stanton says:

    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

  12. 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

  13. 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!

  14. Jeff Haynes says:

    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.

      • Jeff Haynes says:

        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.

  15. Jim Stanton says:

    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

    • Jeff Haynes says:

      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.

        • Jeff Haynes says:

          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.

          • Jeff Haynes says:

            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.

  16. Barefoot Everett says:

    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.

  17. Jeff Haynes says:

    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.

      • Jeff Haynes says:

        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?

  18. 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.

  19. 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

      • Jeff Haynes says:

        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.

          • Jeff Haynes says:

            Hi Sock Doc
            Just to bring a bit more to date progress on my achilles tendon problem. I mentioned in my last post that I was resting to try to give my left heel a chance to get it self right. Well after about 6 weeks rest from running (I kept on cycling through this period) there was little improvement. So I have steadily gone from walking to walk/jog to running continuously using my newly obtained heart rate monitor – trying to keep all my exercise within aerobic heart beat range. I have improved but I have had to regress back to 6mm drop shoes 50-60% of the time when running but running occasionally in my Merrell Trail Gloves. I don’t get any severe pain anymore but a little soreness now and then. I can run up to an hour continually aswell which is great. However, I am running at a pitiful 9min 30secs per mile with little improvement in pace as my max aerobic heart rate won’t allow me to run faster at the moment. I have been at it for some 6 weeks now. Will this improve? and how long should this take? I am itching to get back to 8min mile pace but don’t want to wreck my progress.

          • I’d like to think that after 6 weeks you would have made some improvement. The 180-age formula might now work for you which means you should test your LT via one of the other means I mention. http://sock-doc.com/2011/03/aerobic-or-anaerobic/

  20. Diego Prado says:

    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…

  21. 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.

  22. Terrance Reed says:

    Hi Sock Doc!

    i am an overweight guy and last year i fractured my ankle. I didnt know until two months later after i did it. But as I was getting a splint on my leg the doc told me I had some tendonitis in my achillies. i wore the splint for a month. I’m not a runner or exerciser but my job requires me to stand and walk for long periods of time and sometimes the tendon or bursa flares up and becomes so painful that I can hardly walk on my left ankle. I don’t know if I tweaked a muscle…but I am leaning toward my weight having something to do with it. other than losing weight and the methods you use to relieve pain..is there anything else I can or should do?

    • Ideally you need someone to treat that area for you – maybe a rolfer or a chiropractic doc. You most likely have significant muscle imbalances in the area that need to be corrected.

  23. Hi Soc Doc,
    I have a genuine question regarding taking the right approach to healing achilles tendonitis and preventing in the first place. I have been really trying to get myself to more minimalist footwear more permanently but after a couple years of on and off success, I find myself not quite sure which direction to take. I sincerely believe that less is better and agree with you on this point but the reality is I’ve been unable to successfully make a permanent transition and almost always end up getting some kind of foot/ankle injury. Nothing too serious but enough to force me back to a more cushioned traditional shoe. My latest issue is achilles tendonitis. My question is, some info I read from various sources, recommend elevating the heel (to relieve stress on the tendon), and correcting too much pronation, as well as providing some cushion under the heel. I know this is not what you recommend but would this be a good temporary solution until pain is gone and then work back towards a more minimal shoe? Wouldn’t putting my heel in a flatter unsupported position put more stress on the tendon?
    Thanks in advance for any input. On a side note, I am making sure to avoid all processed/refined/foods, sugar, etc.

    • Yeah I don’t really like elevating the heel (on one side via a lift) I’d rather see you just go back towards a shoe that has it normally built into the footwear – so a type of transitional shoe. Personally in regards to heel lift and cushion, I think the Nike Frees are great for that. I will have patients start with the Free + then move to the 3.0 and then eventually to a firmer shoe like a NB Min Trail and then finally to a zero drop VivoBarefoot or something similar.

      Yes the more flat the heel the more stress on the tendon – but, although correct, isn’t the way to look at it since you’re talking about a natural position. So look at it that when the heel is elevated you’re (un)unaturally shortening the Achilles – so when you get out of those types of shoes it naturally elongates (stretches).

      Makes sure you read this too since you’re having problems getting to minimalist territory: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

  24. Paul Lalancette says:

    Hi Soc Doc,

    I have been suffering through achillies tendonosis/itis for the past 4 months. I’m 24 and have been running competitively for 10 years with no prior injuries. I recently moved to a hilly location and was averaging about 40 miles a week when my right achillies became injured. I woke the next day after a 10 mile run with a super stiff foot and and pain on my upper achillies and insertional region on the heel. I stopped running right away and saw foot doctor who specializes in running bio-mechanics/injuries. He studied my stride, gait, hip movement/alignment, leg length, and pronation. He said that I had perfect form: midfoot stike, with a zero pronation(I was wearing the correct footwear for my foot type). He then concluded that my injury was due to overtraining and not bio-mechanical. My MRI and XRAY showed no bone growths or bursitis issues. I did however have plenty of microtrauma/scar tissue at the top of my achillies and at the insertion. He perscirbed physical therapy(eccentric exercises, light streching, ASTYM treatment, and ultrasound) and naproxin for the first two weeks.
    So after three months of treatment, I have not improved at all and am in pain if I try to run even a 1/4 mile. My only step forward is no stiff anymore when rising out of bed in the morning. I went back for two follow up visits with my doctor and he seemed perplexed and discouraged. He stated that my condition is chronic and due to lack of blood to that it might take many more months to sort its self out.
    My question(s) to you are what are my options at this point if any? Do I need to try other therapies? Is it possible to truly get this heal this condition and return to running? After listening to you video I regret performing bent knee soleus streches for the past 12 weeks. Thanks for your time.

    • Since the conventional methods have got you nowhere then there’s no reason not to try the ones I describe. So those are your options. Have you tried them yet and if so for how long?

      • Paul Lalancette says:

        Before my injury occured I was training in and rotating 3 pairs of Nike Free 4.0 V2. I switched to a more minimalist shoe two years ago after finnishing up my college running. Since my injury I haven’t worn any orthos or heal lifts. I haven’t been doing active release techinques as you decribed in you video, but have been using a pro grid foam roller for the past 2 months at home to hopefully break up the scar tissue. Since seeing you video(about a week ago), I have been performing those message techniques with minor improvement so far. Should I consider going to see rolfer or a chiropractic doctor?

        • That’s definitely worth a try. A lot of chiropractors practice different techniques – many recommend orthotics and don’t do any soft tissue work so you should ask around first. Rolfers are great too.

  25. tedmetzger says:

    Subject: Exacerbation of Achilles tendonosis.. Eccentrics?

    Message Body:
    Hi.. I am a radiologist here in CT who does a lot of sports medicine imaging, and marathon runner who has battled achilles tendonosis for years.. just recovered from a partial tear last year.. slowly rebuilding since Feb…. Been running in Inov-8′s with a 6m drop and Newtons.. just did a half this past June with no issues, but two weeks later.. BAM. Mr Achilles is ANGRY .. doing my foam rolling etc and staying away from stretching.. Achilles though does throb during the day especially after walking…. running 30-40 minutes on the treadmill is fine and actually, my tendon feels best when I run.. What are your thoughts on the Alfredson drop downs now to strengthen the calf/achilles… or, am I actually doing eccentric loading by running midfoot etc in my Newtons and Inov-8s?.. I have the NYC marathon in November and am getting anxious.. Thanks, Ted

    • I personally don’t use or recommend those drop downs. Though I don’t think they’re harmful, I just don’t see the benefit as much as other therapies – trigger point work and total body rehabilitation using natural motions (such as running or light jumping if the AT can handle it), rather than isolating/compartmentalizing a muscle. Though this isn’t as much as an issue with the drop downs as it is say for a rotator cuff problem, I still would not be doing a significant amount of this type of rehab, especially to the point where you’re over-stretching the tendon on the eccentric drop down portion.

  26. All of my leg issues are from over-training and not doing any strength conditioning before starting my cardio. I first got Shin Splints on both legs a few years ago from jogging on a concrete basketball court and over-training. I researched to do “toe-raises” where you place a 50 lbs plate or heavier over your toes and raise up. I do only 2-3 sets of 20 reps and I instantly feel better the same day. Once I solved that problem and started over-training this year on a hard surface basketball court and have AT right at the heal-bone on my right side. It’s definitely from over-training and from not first having strengthened my calve muscles using calf-raises before starting the cardio.

    The first day or two after my 45 minute cardio session, which is a mixture of fast jogging and slow jogging around a basketball court shooting hoops I have mild to moderate pain and it hurts to walk on it when waking up from a sleep. My AT is not serious, after 4 days of rest I have no pain but some minor creaking and some muscle spasms in the lower Achilles Tendon where it meets the heal bone. I have been dealing with my AT for about 3 months now and want to get to the bottom of it to prevent further damage. I like your recommendations of not stretching, resting it, toning down the intensity of cardio, and trigger-point or roller message. How long should I rest the AT before I start doing calf-raises to strengthen the tendon back up to endure my regular 40-50 minute jog? Also, when I eventually do get back on the court, should I make it a regular thing to ice my AT?

    • I think you’re missing the point here. The idea is not to get it so you can go back to doing calf raises but to get it so you don’t “need” to do them. They haven’t done anything for you in the past – in respect to preventing an injury. Here at SockDoc we don’t isolate and compartmentalize muscles – so you run and walk and jump to naturally strengthen the foot and lower leg once you have properly treated the injury. Treatment involves no stretching, NO ICE (as per the First Aid Series – Part II), and proper active rest and trigger point work.

  27. I am developing a small “pump bump” after about three months of PF/AT pain. I’ve had PF/Shin Splint problems in the past but managed to train for the first few months of the year pain free.

    Before the pain started I was training for 5ks (in Newton’s) and my mileage topped off at around 5-8 miles per week. The pain started gradually in May/June and as it worsened I stopped running. After watching your video I believe it maybe started because of a few incidents of very tight calves due to overuse. I’ve ran less than 2 miles in the past 60 days, my calves do not have any tender spots but the AT type pain has gotten worse.

    I’ve continued walking (usually 1-4 miles a day) and hiking once a month (when the pain allows). Walking has started to hurt more and now I’m walking with a slight limp- wearing shoes hurts and going barefoot hurts (I’m reluctant to wear my Vibram 5 Fingers or Merrel Gloves because it seems to hurt more).

    Should I limit my walking? Should I wear the barefoot shoes even though it hurts?

  28. Jim Stanton says:

    Check and see if you have Mortons foot. I chased AT pain for 9 months…turns out I have a structural issue with one foot. A 6 mm lift under the first metatarsal head and the pain was gone the next day and has not been back. I’m in the process of easing back into minimal shoes so for so good.

  29. Hi Sock Doc!

    Just discovered your site and I love it! Thank you so much. As a child/teen I studied ballet avidly. After 15 years of no ballet and just Bikram Yoga and weight training I have decided to take it up again. Three weeks ago I started. Perhaps I am doing too much too soon. 5-six classes a week. I am not on pointe nor am I doing any jumping as I am in the process of strengthening my VMO on my right leg. Had MRI last year on right knee and that is what the Dr. suggested. Well last Thursday or so I started feeling pain in my right Achilles area when I pointed my foot or went onto the balls of my feet (demi-pointe). I have been icing 3-4 times a day, taking Aleve, and resting. When do you think it will be safe for me to start back. I am still having pain on my Achilles and after wearing heels yesterday for about 1 hour I noticed some swelling. I am anxiously awaiting going back to class.

    Thank you very much!

    Elizabeth

  30. Hi Sock Doc!

    I have recently got a lump on the back of my foot, it is so painful to touch and when I wear shoes as it rubs against it causing pain. I all started when I stared a new year at school and changed my shoes, the first week was okay but after that there was a lot of pain so painful it was hard to walk. It don’t hurt without shoes on its when I wear shoes. Its most painful in the mornings but for school I have changed my shoes as I cant wear any others, these shoes dont rub at the back which is good but I need help on getting rid of this lump for good, any help you could give me please?

    Thanks

    • The best suggestion I can give you is to follow the advice in the AT video. It works! And wear sandals or something that doesn’t irritate that heal until the swelling calms down.

  31. Aguila Calva says:

    Doc is there any chance you could put up a video on one of the most common running injuries, post tib tendonitis?

    • Thanks for the suggestion but that type of injury also results in plantar fasciitis as well shin splints. I discuss it in both those videos AND the foot pain video. So already plenty on it. But you’re right – it is the most common for 2 reasons. 1) it controls normal pronation 2) it’s associated with adrenal gland dysfunction = stress (overtraining, diet, etc).

      • Aguila Calva says:

        ok

        what about FHL? I understand that its not important as to what i have but how i got it but i feel it’s very important to know what I have so I can address it, especially when I know why I have the injury. Overuse. Had this post tib pain for too long now. But last two times of reoccurence, the post tib pain was accompanied by big toe tendon pain. Apparently post tib tendonitis can be confused with FHL. If these too pains accompany each other does it sound like FHL to you. I’ve had So much rest and recovery with good paleo type diet, whole body exercise like swimming and resting the foot with no weight bearing. I feel if i knew what i had i could treat the right areas with trigger point and really workout everything from there. Physio thinks its post tib but i don’t think so. So frustrated :-(

        Submitted on 2012/10/10 at 11:19 pm | In reply to Aguila Calva.

        sorry, EHL

        • I’d say EHL (extensor hallucis longus) accompanies tib anterior problems, and FHL (flexor hallucis longus) with tib posterior.

          Don’t get into the mindset of trying to get a perfect diagnosis or figure out exactly what muscle is involved. That’s not the point. There is almost always more than one muscle that is involved. I rarely see a problem with the EHL, that’s why I don’t have a video on it. You can check it though – just check the front of the fibula rather than the back where the FHL starts. But in either case – FHL or EHL – it’s usually more involved than that. Those big toe muscles are reacting to something else.

          • Aguila Calva says:

            No tenderness around the fibula. It’s definitely specific to the the big toe being curled back. When i hold the other four toes down and flex i feel it. When i hold down the big toe and flex the others i dont. defo EHL pain. Ok so i will try not to concentrate on exact diagnosis. Just stick to diet, fats, sleep and stress. What about a wobble board for rehab i think this would target both areas? The physio says it could be my control when i place my foot that seems to cause the problem hence the overuse. She assessed my stance. My feet flatten when i totally relax, Arches fall, post tib invert, knees invert. (the right ankle never gives problems). But if i add a little control the arch lifts but i have to actually do this unnaturally like an exercise and if i hold the posture then the post anterior works hard. Do you think muscle imbalance could be a culprit in the post tib? I know the big toe has come from the post tib no longer able to support so the stress went to the next available support. What is the entagonist for the post tib tendon/muscle and also EHL? I’m thinking self rehab before i decide to run again. Wobble board, do some little basic Movnat balance exercises on and around our perimiter wall, bear crawls front and back, stuff like that.

          • Yeah I like wobble boards. Antagonist to the tib post is peroneus longus (see Foot Pain Video) and of course tib anterior. But really can’t look at it as so much that way (like biceps-triceps) as the foot is so dynamic, especially the tib posterior.

            And yes when there is an injury a muscle imbalance is involved 100% of the time.

  32. Fascinating. Orthopedic doc at Mayo said the complete opposite. Guess I’ll try your methods before taking Mayo suggestions. Check out their synopsis:

    “Recommendations and Treatment: Two-centimeter heel lifts recommended as his
    sole source of treatment to help relax the Achilles tendon while walking;
    1-cm heel lift will be inserted inside the shoe which is adjustable and once
    he becomes more successful he can remove a small layer at a time from each of
    his shoes as he progresses. Additional 1 cm will be also applied by local
    orthotist or prosthetic establishment as a prescription was dispensed for
    additional 1 cm to the exterior of his shoes, totaling 2 cm. Some light
    stretching exercises also recommended for his Achilles, and given some time this
    should self correct.”

    • Why does everyone think that institutions like Mayo and Johns Hopkins are so great? I don’t get it. I see the same “show” at renowned Duke. There is a time to seek their care – when you’re dying, broken (literally), very sick, or you need further diagnostic information. But let’s not actually think that you’re going to get to the root of a problem – aside from one or two “outside the box” docs there.

      Your synopsis is hilarious. Though heel lifts do take pressure off acute AT, so people tend to like them. Obviously not the fix, but a patch-job. Looks like you’ll be about 1″ taller too! Yeah!

  33. I have been running in minimal footwear for about a year now ( I run in vffs and merrell bare access) and I believe I have been dealing with achilles tendonitis.

    My questions are:
    1: How should I go about treating this issue. Should I stop running all together, and for how long?
    2: How will I know if it is all better? I rested for a couple of weeks, felt no pain and went for a 1 mile run and then the pain came back.
    3: When I do go back to running should I continue to run in both footwear, or should I use one rather then the other? Also what should be my plan when I do begin to run again.

    Sorry for all the questions. I want to make sure I get this right so that this doesn’t become a prolonged issue.

    I am running the NYC Marathon next year so I desperately need to get healthy and start training!

    Thank you!

    • Best advice I can give you w/o seeing you is to watch the Achilles Tendonitis Video on the SD site. If it comes back it’s because you haven’t solved the issue – which is usually an adrenal/hormonal problem or a gait problem from past injuries.
      Run in whatever type of footwear works best for you. The flatter the better but also the more that will tax an Achilles if you’re not ready for zero-drop.

  34. I have a somewhat complicated shoe issue. Or at least, I am making it complicated by my fear of different shoes. I have had one achilles reconstructed and the other repaired. I have had gastroc. recession on both calves. One the repair side, I had a bone spur removed as well, that was wearing on the achilles. I have been wearing brooks glycerine and ghost because of the cushioning. I am afraid to wear a mininalist shoe because I don’t want any more serious problems.. I am very athletic but have been struggling lately.. That is the short version of the story.

    • You’ve got to do what is right for you. If you don’t think you can go minimalist now, then don’t. It could make your struggle worse, though it could help. Obviously that is some major surgery you’ve had done and cases like this need to be assessed and treated on a case-by-case basis.

  35. I am a minimalist (zero drop) runner with achilles tendonitis. My question is, while I am taking a break from running until my achilles pain goes away, should I avoid being in VFF/4mm drop shoes for most of the day. Should I go back to regular shoes until the pain is gone?

    • That’s a tough call. If you were in my office I’d say no – you shouldn’t go past 4mm. But I’d be working on things to correct the problem. >4mm might take some strain off the calf/Achilles but in the long run that will only shorten up the tendon again. So you need to find the balance between what is going to heal you up the fastest and not cause a problem in your gait, or other muscle imbalances.

  36. Very useful video, thank you.

    What are your thoughts on “taping” the ankle? I had an athletic trainer tape my ankle and it felt good. I had rested about a week, went running again yesterday with my ankle taped, but the pain came back. I have an 8K race this Saturday, but I feel discomfort just walking. I’m considering not running it :( I’m also training for my 1st marathon in February and don’t want to mess it up more.

    • Taping is okay for a very short term (a few days at most). If you tape too long then you are basically bracing/supporting an area that is trying to heal up and if you have to use tape to be able to run then you shouldn’t be running until you’re healed.

      You’re training for a marathon in February. There’s absolutely no reason you should run your 8K this weekend since you’re injured. Bag it.

  37. Bobbie Purcell says:

    I just watched your video on achilles tendonitis, seeking a name for my injury. I’m pretty sure I jumped into minimalist running too quickly. I have calf soreness, but the most pain is on the outside of both feet, between the ankle bone and heel. I have no pain on the backs of my ankles. What do you think?

  38. Hi Doc,
    I have read so many different things, that I’m not even sure what I have. I will describe it the best I can, without rambling on :). Years ago my heels started to hurt, more and more every year. At work, I am on my feet all day, I also tend to lean on one leg more, that heel hurts more. I have always played sports, baseball, hockey, hoop. What developed years ago was a pain in the back/and sides of my heel. Getting up in the morning the heels will be very stiff, but walking a bit they feel better, I drive to work, half hr, get out of car, they hurt again, but after a half hr or so of walking at work, they feel pretty good. Sometimes driving home after work, they hurt while I drive, I think it could be the way my heels hit the floor. Now, if I play a sport, floor hockey for example, and I run hard for an hr, that evening my heels start to stiff, by morning when I get up, wow! I shuffle, and painful, it will take me twice as long to get them to the point that I can even walk a little, and they never really get better for at least a week, then slowly they start to go back to the way they were, and that’s if I don’t do anything as far as running. I have not really read about someone having this. I have pretty much given up the hard running. Most of the time, when warmed up :) I can walk fine, hardly any pain. Pushing in the side or the back of the heel, I can feel some pain to the touch. I do have a bit of a bump on the heel. Have gone to the doctor years ago, gave me a boot, stretch exercises and ice. Helped at the moment for a little while. My shoes stink, looking into new ones for everything. Just would like your take on this all, especially the part of hard running, and the next day I’m a basket case. Recap, I can walk all day, hike, and even ice skate or roller blade, and not much pain, next day the typical stiff but once warmed up I’m ok. Any kind of hard running, next day even when warmed up, I’m in major pain when trying to walk, and it will last all week all day. Hope it all makes sense.
    Thanks so much
    Billy

    • I’d say you have a pretty obvious fascial problem from calf muscles that are too tight, affecting your Achilles and plantar fascia. These muscles, as you have read, have a lot to do with all types of stress I discuss all over this site. So this is two steps for you. 1) find the trigger points as I discuss and show in the videos and work them out 2) figure out and adjust the lifestyle stressors that are causing the muscle imbalances in your lower leg/foot. #2 is easier said than done, but that is where the problem is stemming from and the reason you a wreck after a hard workout.

  39. Hi Doc,

    I’ve acquired acute bilateral achilles tendinitis 2 weeks ago. I was off of exercising for a long time and wanted to get back. So I started cycling at the gym. The morning after day two, I noticed pain in both of my achilles and knew immediately what it was and have decided to stop walking. I’ve been in a wheelchair since and have been afraid to walk because I feel that it might increase inflammation. (I walked today and it started to hurt a little more) I’ve also opted for an anti-inflammatory diet, and have been icing. I’m starting to do the trigger point massages and have ordered the stick.

    I just have a few questions: Should I continue to use a wheelchair and slowly wean off of it as I feel more ready? Should I use a voltaren gel and get ultrasound done, as was prescribed to me by my ortho doc? Is there anything else I can do? I am very careful with this injury because I know it can easily get worse.

    Thanks,
    Tawny

  40. Andrew Hostetler says:

    Hey Doc,

    I’m dealing with some achilles tendonitis at the moment post 50 mile race. I’m rolling/massaging out my calf, staying off it (I’m on crutches), relaxing, and eating well. Would it help to use compression around my lower calf and heel? Could a sports wrap help to stabilize and provide compression?

    • Yeah that’s a good time to use a compression sock (full or mid calf). Easy on those crutches (unless it’s really that bad) – a lot of people screw up the other leg using them too much/too long.

  41. Hi Dr Gangemi,

    I’m a 46-year-old salsa dancer with recurring Achilles tendinitis/osis or whatever it’s being called these days. I get it in both legs, but more so on the left, which is the feebler one.

    I watched your video with great interest and have been using a wooden massage thingummy to ‘iron out’ the tender bits further up my calves which, of course, works. However, I’m confused by one thing you say, which is to wear shoes that are as close to being barefoot as possible.

    I actually prefer to dance in soft jazz pumps because it makes me feel more grounded. However, it’s dancing in the flatties that brings on the AT. When I dance in high heels, it doesn’t happen so often. Instead, I get what I call ‘salsa toe’, which is a numb big toe and second toe from being on the balls of my feet for hours. This can take all of the next day to wear off!

    I feel as if I’m in a bit of a catch 22 situation, so I’d appreciate your advice.

    Looking forward to hearing your thoughts.

    • When you elevate the heel you’re taking pressure off the Achilles, so that’s why it feels better. Sounds like you have other imbalances in the foot – you might want to check out the other videos as well as the Injury First Aid Series. AT is most common due to too much stress, of any type.

      • Thank you so much for your reply. I’ll defo be checking out all the other nooks and crannies of your website in due course :o)

  42. Hi Sock Doc,
    im from Chile and have achilles tendonosis on both feet and i love to play basketball. Which are your recommendations for healing my problem taking notice that in basketball having great cushioning in shoes is fundamental.

    • The advice is the same as I give in the video and to limit the amount of cushion in your footwear. And the more heel you have in typically basketball “hi-tops” the more you will shorten the Achilles – which can be problematic.

  43. I am a triathlete trying to recover from achilles tendonitis. I have been swimming recently with no problems and am looking to add some cycling. Do you think it would be ok for m to do some cycling, and if so should I keep it to easy flat terrain or no? Thanks

    • If you can do the exercises in the new Foot Strength Video then you should be able to handle the bike, per the SD Training Principles.

      • The single leg calf raises and jogging in place are safe to do with my Achilles tendonitis? And when you say “if you can do those exercises” do you mean do them without absolutely no pain or do you mean just capable of completing them?

        • I mean both (referring to the new video: http://sock-doc.com/2013/01/foot_strength-foot_rehabilitation/).
          You should be able to do them with no pain and controlled. If you have bad AT, then you won’t be able to do the exercises, but as it’s healing you’ll be able (should be able) to do more and more of them and it will help prevent another problem in the future.

          • Thanks for the help. I really appreciate and truly believe in your beliefs and advice on moving naturally and being barefoot. I would love to be able to come in for a consultation but I live in NYC. Are there are doctors, podiatrist, or chiropractors in NYC that you would recommend, or even any advice on how I could find one that shares in your philosophies?

          • Sorry I don’t refer much. You have to find the therapist, not the therapy. Look for a doc/therapist who treats the whole body and understands how it’s all connected.

  44. Hi Sock Doc
    I would like to thank you for your website & all the information that you give. I have been following the information you give with regards to the trigger points & also strengthening my feet, I live in South-Africa & started getting Achilles’ trouble when I played rugby a few years ago. I got to the point that I can run without pain in my AT but the problem I have is that my Feet & AT are very stiff & sore for the first few steps in the morning & also when I stand up after sitting I while behind the pc at work. Do you have any suggestions on how I can overcome this? Thanks again.

    • Check out the Plantar Fasciitis Video and work the trigger points for the tibialis posterior – that’s usually the muscle that causes the morning pain.

      • I watched the video for Plantar Fasciitis & dit the trigger points & it really felt much better this morning. Thanks for the advice & video. So do you think its more a Plantar Fasciitis problem than AT problem?

        • Based off what you said, that would make more sense but remember it doesn’t matter what you have (the diagnosis) but how you got it (the processes leading up to the injury).

  45. Thanks for the advise on the plantar fasciitis & the trigger points. At the moment I’m concentrating on strenghtening my feet working the trigger points, what I would like to ask you if there is a connection between your feet & your Glutes because the last couple of days after I go for a run & I sit down at work I get this constant pain in my glutes could this be because i’ve got weak glutes? Sorry for asking but I’m not sure how to get rid of this pain thanks.

  46. Hey Sock Doc

    I injured my heel on the corner of a night stand when I dove on the bed pretending I was superman to my kid, super painful swelled up got really big I had exrays, nothing broke its been a about 1 yr since. I still have a lump on my heel about the same spot you have in the video. I went to a doctor and they want to do surgery Im not excited about that. I have had trigger point rubbing done to my calf leg it feels great for a day then after that back to regular old pain I dont know what to do.

    • Read the article on trigger points to understand why the pain keeps coming back. And I’d see a naturally minded doc before having surgery.

  47. Doc,

    I want to thank you for helping me with this problem plus the questions you answered on ITBS. I healed from both, and completed my first marathon this past Sunday. I’m sore as hell, but enjoying the fact that I ran pain-free :D

    You rock \m/

  48. Jeff Haynes says:

    Hi Sock Doc
    Just a quick follow up to say that I am now doing a lot better than I have done in ages. I am running in zero level Vivo Barefoot Neo shoes for all of my running now. I can run further than I have for a long time running up to 7 miles. There is none or very little discomfort in my left Achilles when I run, and I have even done some races recently. I had the chance to have some one to one training from a vivo barefoot coach recently which was interesting, he verified that my natural running style is about right checking my posture, rhythm and foot strike and gave me some exercises to perform to improve further. I still search for trigger points to massage out and I am careful to keep anaerobic running to a minimum. It seems to work, thanks for all the information on this site and for your responses. Running pain free is a big relief and the enjoyment is returning again.

    • Great to hear Jeff!

      • Jeff Haynes says:

        After all I have said – yesterday I went out for a 7.5mile run – the longest for a long time and I find that both my heels are sore! Mind you last week I did do a lot more running than usual so it may be a ‘too much too soon’ scenario. Top of my right foot was also very painfiul. Is it ok to regress now and then to other minimalist shoes? to give my heels a bit of rest. Or should I just do less in my Neos for a while?

  49. Hey sock doc I commented on the PF article a few days ago asking about a heel spur and you sent me the link to this video. I see the info that you talk about in the video about the heel spur or pump bump but I meant a heel spur underneath the foot almost right where the PF originates at the calcaneal tuberosity. I was curious about the treatment of this sports related injury because I have a close friend getting both heel spurs surgically repaired which I didn’t know was necessary. Would love to hear you thoughts on the optimal treatment of this injury. Thank you.

    • Heel spurs are going to occur where the connective tissue attaches to the bone. So ideally you’re looking for muscle/fascial trigger points a bit distant from that. So if it’s at the bottom of the calcaneus there then you might look more towards the toes, but it could also be a calf issue pulling on the heel bone from the back.

  50. Ok thanks sock doc, what about surgery do you find its ever necessary for this type of injury? and if it was that severe to warrant a doctor to recommend surgery but it can be healed naturally would the steps simply be to evaluate stress levels, work out the trigger points, and strengthen?

    • It’s always case by case. Remember – don’t be a fool and try to treat something on yourself that needs medical care. But for most, they have unnecessary surgery and other medical interventions.

  51. Hello Sock Doc!

    I’ve been having pain from my right hip down to my right Achilles tendon (off and on) for a little while now. Lately it was Achilles tendonitis so I came about your site to help find ways to heal my injury. So since I’ve learned that it’s not about what I have but WHY I have it, I started acting on reason # 3-4 and 6 of the top 10 reasons why we get injured and worked on my trigger points. Since I don’t know where my injuries originate, I worked trigger points all over my body, especially in my right gastroc and right glutes(even though I find it hard to work on them alone). Almost overnight, the Achilles tendonitis went away :) but I still feel pain in my right hamstring after a run and my right gastroc is almost always sore, so I am continuing the trigger point therapy. I found a sore spot on the inside of my upper right gastroc. When pressure is applied on that spot, I feel a warmth/heat (little painful) sensation go up behind the knee to my hamstring. My question is: Is this normal? Can I worsen my injury by pressing the “wrong” spot?

    Thank you so much for all the great information we can find and easily understand on your site. It is very valuable to the running lover that I am.

    P.S. As I continued reading the posts and answers I saw that I should stop doing my gastroc and foot strengthening exercises, is that correct?

  52. Harry B. says:

    Hi Sock Doc. will try be as concise as possible. had achilles tendonosis in 2009 and 2010. resolved finally after long time with new orthotics. got again in july, 2012. to date, tried ART, graston, dry needling, PT, boot for 3 weeks, more PT, two platelet rich plasma injections with boot for 1-1/2 weeks following each injection. i have NOT run since July. during this time have been swimming, started spinning in december as i was fed up. i have no clue where to turn. ortho said surgery for this is a long recovery 9-12 months with a chance of it not working. i have done eccentrics and weighted eccentrics since july – all to no avail. the achilles hurts all the time. MRI says mild tendonosis but the pain persists. i want to run again so much as that is my passion. i am going to do the self-massaging thing ASAP. i will throw out the orthotics. i know nothing about sneakers. wear addidas super novas now. any recommendations – it is definitely chronic and all treatments have failed. thanks so much. harry

  53. Anne Morton says:

    Dear Sock Doc,
    For 7 years I suffered a knee injury (it was soft tissue so no interventions worked) that made it difficult to walk. A course in Tai Chi walking and a transfer to VivoBarefoot shoes transformed my life and for one year I was joyously happy, walking over an hour a day and feeling great. I live in Paris and have no car so walking is essential to me.
    One year ago (3/31/12)I started to dance the tango, may have overdone it before I knew how to do it correctly and felt a pain in my right achilles tendon. As it went away with walking I assumed it would heal so I kept walking. It got progressively worse. I had every imaginable treatment here in France, physical therapy, ultra sound, acupuncture, rest, compression socks etc. An x-ray and echograph in July showed a small heel spur and no tendon damage. Rest would help as would ice and soaking in epsom salts, but the minute I started walking it came back, to a crippling degree. I hobbled around in terrible pain almost all of the time. In December I had an MRI. It showed that the bone spur had gotten larger (and it seems to be continuing to grow, it shows on my heel and keeps getting larger) and that the tendons were damaged. One doctor here told me there was nothing left to try but an operation, however it wasn’t one that always worked, and two doctors told me it was way too risky especially at my age (I am 74 years old). I went back to California and an orthopedic surgeon also told me it was too risky. Right before I left I saw a specialist in foot and ankle surgery (also the official doctor for the S.F. ballet) who studied the MRI and told me that it would continue to get worse, the bone was growing and causing pain itself, plus the tendons were damaged (tendenosis). All operations were risky but he would go in through the side of the ankle with limited nerves and not cut through the tendon, to remove the bone and repair the tendons. It is something he does all the time and he is not concerned about it healing if I follow directions. My only other option was to have more and more limited mobility.
    There have been so many conflicting opinions. I’ve given up my Vivobarefoot shoes and added a 3 centimeter heel and that does help. I’ve also been given an exercise with an elastic band that stretches the hamstring (you lie down and put the band around your foot, hold it in the air and pull downward) and seems to help (would this come under your stretching criteria and not be wise to continue). And I’m signed up to have the operation on August 2nd.
    This morning I found your website and have watched the video three times and read everything you have written. I definitely found huge trigger points in the low calf, it’s extremely painful there to the touch. Pressure feels painful but good but it still seems sore when I go back and touch it again. I essentially have 3 months ahead of me before I get this operation which I am petrified about. If there is any way I can heal this and walk comfortably again without operating I want to do it.
    I have already started working on the trigger points. My diet is excellent and follows your recommendations. It’s actually been feeling better but one expert said it’s only because I’m taking care of it and not aggravating it, it’s not going away, and my physician who has great faith in the surgeon says it’s one of those things that won’t heal so there is no choice.
    My questions are: 1) Can this heal once it is this far gone, 2) Is there anything else I can do to help it heal, 3) how much actual walking can I do on it while and if it is healing and 4) do I dare try to walk barefoot again (I gave up my Vivobarefoot shoes very reluctantly but every single professional told me I had to elevate the heel a little and it does seem to have helped)
    Thanking you in advance and with appreciation for any advice you can give me.

  54. Jim Stanton says:

    Your story sound a lot like mine (just turned 74 yesterday) I’ve been running for 40 years, three years ago started moving toward barefoot style running. Overdid it big time wound up with chronic pain in the back of my heel. Found out about trigger point therapy. That helped relieve the pain but was not the cure. I struggled with this for 7 months. Then one day I did a search for any known causes of achilles tendenites /osios and found the Mortons Foot site. Followed what they recommended there and in three days the symptoms were gone and have stayed gone for now for 7 months. I have a short 1st metatarsal on my right foot which when you run barefoot style the calf muscles are not activated in the correct order and are overwhelmed. That’s the theory….don’t know if it’s true or not but the 6mm lifts under the metatarsals fixed the problem
    Give it a try you’ve got nothing to loose
    Regards
    Jim Stanton

    • Anne Morton says:

      Hi Jim,
      Thank you so much for your reply. It was very much appreciated. You are just a bit ahead of me, I’ll be 74 in June. I’m glad to see you are still running and figuring out how to cope with the aches and pains. I looked up Morton’s toe and have put some cotton under my metatarsal. I do think it may be part of the issue as I’ve always walked with my toes a bit outward. It also led me to the Trigger Point Therapy book. It is amazing to me that with all the experts I have seen both in France and the U.S. not one has even mentioned this. If I had just known about it a year ago when this all started I might have been able to heal it then. IN fact, I and the experts did all the wrong things and it kept getting worse.
      I have four months to go before I have this operation and if I can cure myself before then I will be incredibly grateful. The problem is that the bone keeps growing, it’s so large now that the tendon is always irritated and always sensitive to the touch. Everything works well, pressing the trigger points, using anti inflammatory treatments like ice and soaking in epsom salts and now the pain has subsided. But when I take up walking for any length of time (I can go about 20 minutes but that is it) the pain comes back. I think it’s like the tendon is rubbing against the bone. The doctor who is a foot specialist says it will only get worse and my mobility will be more and more limited as a) the bone is continuing to grow and b) the tendon has been pretty badly damaged and won’t be able to heal itself. And when the pain gets severe I literally can’t walk, I can barely hobble.
      If I can prove him wrong in the next couple of months I will be thrilled to cancel my operation. I’ll definitely try the pad under the ball of my foot and continue to work on the trigger points. Just wondering if there is any way the bone can actually shrink. I’ll just have to keep experimenting to see what will happen.
      thank you again for the lead, I’m feeling hopeful. Anne

      • Jim Stanton says:

        Hi Anne,
        It’s ironic that your last name is Morton:). Durning my injury period I developed what is referred to as a “pump bump” which is a boney painful to the touch growth on the back of the heel bone. After determining that I needed the 6mm proKinetics inserts, (These are not orthotics in the traditional sense0 and wearing them all the time the first thing I noticed was the bump was no longer painful to the touch and now, 7 months later it has gotten smaller. Needless to say I’m ver happy about this.
        The company I bought my lifts from is Posture Dynamics http://www.prokinetcs.com
        Good luck. I hope this is the answer.
        Regards
        Jim Stanton
        Fairport, New York

        • Anne Morton says:

          Hi Jim,
          I hope I am not becoming a pest but as you are the first and only person who I’ve spoken to (including I can’t even count how many professionals) who has actually recovered from this without an operation I’m feeling compelled to ask a couple more questions. not to mention how contradictory the advice has been.
          1) what do you think about the idea of not stretching. The physical therapists I”ve seen have given me elastic bands to stretch the foot forward and also recommended standing on a step and stretching. It always felt good but it sounds from the Sock Doc like it is not helpful to the healing process. Did you stretch while getting better?
          2) During your recovery period did you ever rest the leg completely like you would have had to do if it were operated on. I have a boot I could wear and was thinking of trying it for a month to see if the absolute rest would help. I’m afraid it might through the rest of my body out though anddon’t want to be too expermimental and end up getting more injured.
          I’m scheduled for the operation on Aug 2. That gives me 3 full months to heal this and cancel and I want to give it a hero’s try. I’m so afraid that if any thing were to go wrong wit an operation I could end up worse than I am and it would be permanent. Even though the doctor is cool about it. I”m keeping a daily journal. It does still get stiff and when I first start to walk I have trouble putting weight on it but it goes away and seems to not get much worse as it did before when I walked.
          Thanking you in advance for your opinions. Anne

          • Jim Stanton says:

            Hi Anne,
            You are not being a pest at all, I’m glad that my experience can be of some use with your injury. That being said let me preface my remarks with 1. I’m not an MD I’m a physicist and a big supporter and user of the scientific method. But I am when all is said and done i am an experiment of one and the results I achieved may not work for you.
            If should read as much as you can on the SockDoc site I have found it all good information. Now to your questions:
            1. I don’t think stretching a weakened tendon or muscle is a good idea. I don’t do any static stretches at all. Have not done so for years.

            2. Early on I did try taking a week off from running and continued treating the trigger points with a tennis ball. It was somewhat better but it was still painful when I first got up in the morning and after sitting for a while. Since I had no intention of quitting running I discontinued the rest period and resumed my easy running schedule and intensive trigger point therapy,which was just treating the symptom. At this point I just continued reading and searching. I also spent a good deal of time examining drawings of the foot and lower leg and reading up on mechanics (physics) of the structure and how it all is supposed to work when running and walking. All during this time I kept on an easy aerobic running schedule. Once I warmed up there was no pain it returned after I cooled off. By now, several months, it became chronic and was the same pattern day in and day out. Then I discovered the proKinetics insoles for the treatment of Mortons foot issues.
            I urge you to try their starter kit. ( I don’t get a commission) But they really work for me. I have 4 pair and have them in all my shoes. One other thing I did go back to traditional running shoes for my daily runs and go “barefoot” the rest of the day. I wear my Vivibarefoots only in races about once or twice a month. My feet are getting stronger all the time and I have not had any issues with the vivo’s this time around.
            Hope this helps, if you have any more questions let me know
            Regards
            Jim Stanton

          • Anne Morton says:

            Dear Jim,
            Last night I had a consultation with Bjorn of Prokinectics over the phone and it was very enlightening. We did a test and there is no question that I have morton’s toe and that I am way over pronating on the leg that’s injured. It is also much shorter than the other leg. I have ordered what I need and the inserts should arrive in 3 or 4 days. I”ve also taken out one heel lift from my left shoe and in a week will take out the other. I am extremely hopeful.
            Now it will be a question of putting it all into practice and giving it time to heal. I am very optimistic.
            Again, I can’t thank you enough for sending me in this direction.
            Best regards,
            Anne

          • Jim Stanton says:

            Hi again Anne,
            You are very welcome, glad to be of help.I know how important having pain free mobility is and hopefully the inserts will correct the root cause of your problem.
            Please drop me a note in a month or so and let me know how you are doing. jXXXXXXX@gmail.com

            Take care
            Jim

            (Jim – I sent Anne your email privately) SD

          • Anne Morton says:

            Hi Jim,
            I just wanted to get back to you to let you know that I am wearing the prokinectics and feeling much much better. I still have burning sensations at times, the bump is larger and tender to the touch, and every now and then a bit of limping is necessary. But overall I’m walking with no pain and have not had any relapses. I’m very hopeful now and will give it until the end of June but am almost certain I’ll be able to cancel the operation that is scheduled for Aug 2nd. Am doing all the other things as well (trigger therapy, good diet, soaking in magnesium salts). I can’t thank you enough for introducing me to Morton’s foot, incredible that i’d never heard of it before.
            Best regards,
            Anne

          • jim Stanton says:

            Hi Ann,
            That’s great news ‘m very happy for you. I know what a great relief it is to have a treatment work. I know when I first tried the proKinetic inserts I had significant relief within 3 days. The 3.5mm lift did not do much good so I quickly switched to the 6mm and it was like magic. I don’t really know why they stop at 6mm. You might want to ask them if perhaps you might need say 8mm. Also there is lots of good information on the Sock-Doc site about strengthening your feet that you might want to start if you haven’t already. Hope you can cancel the surgery.
            Get well and stay that way
            Best regards
            Jim

    • Anne Morton says:

      Jim, I want to thank you again. I’m not sure this will solve my problem, it may be too far gone, but maybe not. Today I made two pads for the balls of my feet from a kitchen sponge and probably for the first time in my life walked correctly. It felt great, completely balanced. I always try to keep my feet pointed forward but it never works and I also fall back into old habits, who knew it was because of how my feet were shaped. It’s only one day but walking felt great and my tendonitis was not activated.
      I can’t tell you how happy I am that you answered my post and led me to this investigation—and just maybe a cure!! Anne

      • jim Stanton says:

        Anne, Good luck to you.I think the human body is an amazing thing…it’s programmed to heal itself if you give it half a chance.
        Regards
        Jim

        • Jeff Haynes says:

          Hi Jim
          I have followed your rapport with Anne Morton re. achilles problem with some interest. I have posted here before and I think you have sympathised with my case, at least on one occasion. I wondered if I could just outline where I am now with my heel problem.
          I am still transitioning from clod hopper trainers to zero Vivo Barefoot shoes which I use a lot these days. My original problem was heel pain at the back of my left heel, this has now subsided a lot, probably because I have applied a lot of Soc Docs wise advice. I started to transition some 18 months ago really because nothing else worked with my condition. I am a lot better but the pain seems to have transferred to my right foot and at present I am resting for a few weeks to try let things settle. I cycle in the meantime to keep some fitness going.
          I am now wondering if I may have a slight Mortons foot problem. It is not severe, as it is difficult to know if that 2nd Metatarsal is in fact longer than the 1st they are so close in size. However, I get a hard callous under the 2nd metarsal just behind the 2nd toe on each foot, which may point to me having Mortons Toe/Foot. I have to rub this off regularly otherwise it causes its own sore spot.
          Recently I have managed to do some fast running in training without too much problem but I may give these ProKinetics Insoles a try if I can get hold of a pair in the UK.
          Any help or comments would be grateful.
          Regards
          Jeff

          • Anne Morton says:

            Thanks for the kind thoughts Jim.
            Here is a way I read about to tell you if you have Morton’s foot even if the 2nd toe isn’t larger. When you separate your toes the space between the big toe and the 2nd toe should be exactly the same as between the 2nd and the 3rd. In my case the opening between the 2nd and the 3rd ended much higher up which verified Morton’s foot.
            I believe you can buy prokinectics in England. I ordered mine from the U.S. and had to pay 43 euro to the French customs to receive them in Paris. I think had I ordered them from England I could have avoided this.
            Good luck with them. They are really making a difference for me.

          • jim Stanton says:

            Hi Jeff,
            Mortons foot can cause nasty hard to diagnose problems throughout the body. In the case of a “natural” quasi barefoot runner it causes the timing of the muscles that support the arch and other parts to be out of sync so the foot is unable to provide the proper impact absorption and subsequent rigidity.At least that what the patents covering the proKinetics say. It also is what I experienced.
            Ann’s description is a good one, it’s not just a long second toe as many people think.
            The company is Posture Dynamics, Inc, Olympia, WA 888-790-4100. If you call them or go to the site http://www.prokinetics.com there is lots of information there. (I do not get a commission for promoting these).
            It’s taken me three years to transition to natural running (vivobarefoot shoes running and dress) with a lot of pain along the way. I have four pair of the 6mm inserts and wear them all the time and have been pain free and trigger point free for the last 8 months
            Let me know if I can be of any further help.
            Regards
            Jim Stanton

        • Jeff Haynes says:

          Hi Jim
          Thanks for your reply and the helpful info. Instead of launching in and paying a heap of money to buy these Prokinetics insoles, I have today put a few layers of rubber foam (each layer 2mm thick) which is reasonably firm, under each 1st metatarsal, stuck to the bottom of the footbed, into my Vivo Neo shoes which I am walking around in most of the time. I wanted to see exactly what it feels like to have this area elevated. Not sure quite how much to build it up but I will let you know how I get on. It feels a bit strange but I do feel a bit more stable when walking. Not running at the moment, so I guess the real test is when I go for my 1st morning run.
          Regards
          Jeff

          • Jim Stanton says:

            Hi Jeff,
            That’s a smart way to test for Morton’s foot. I used Oder Eaters insoles and Mole-foam for the small buildup under the first metatarsi. My pain was in my right heel and when I first used the makeshift lifts I could really feel it in my right foot, felt like a lump. But I did not notice any sensation in my left foot. Now, 8 months later each foot feels the same and strength and balance has returned to my right foot. Initially I could not do a simple heel lift with my right foot. Now I do 90-100 every other day on both feet with ease.

            Good luck
            Jim

  55. Austin Gallagher says:

    Dear Sock Doc,

    I’ve had Achilles tendonitis in both legs for what’s going on a year now and mannn words cannot describe how eager I am to get rid of it. I took notice the reason I may have had it this long is because I’ve been exhausting the therapies you mention don’t work in the video (stretching, orthotics, etc). Just to give you an idea of my situation, I’m an 18 yr old athlete aspiring to play football this summer if I can get through this injury. I’ve been working out on an elliptical to avoid that chronic pain but my job requires me to be on my feet for hrs. I gotta get rid of this so I can lace those cleats back up. ANY ADVICE WOULD BE MUCH APPRECIATED!!

    Thanks Doc

  56. Sock Doc,
    Overwhelmed by the vast vault of knowledge you provide here, and more so at my astonishing lack of it…or the autopilot that sends me scuttling to the medicine cabinet and doctor at the first sign of injury also known as “willfully self inflicted pain” because I seriously don’t like addressing the WHY of it all. Wow! Check out the previous triple run on sentence! Anyway ignorance is not bliss. A pesky and very painful Achilles issue sent me to the doctor’s office in full panic mode. More than likely, it’s one of the infamous itises (is that even a word?) associated with the achilles. Only hurts wearing shoes. Doesn’t hurt from touching it at all, which is weird. I’ve never had an achilles problem, and apparently I still don’t. The poor thing was overcompensating for a neglected calf muscle. After watching one of your trigger point vids about seeking the culprit responsible for it (me-duh), I located the most insane knots in my calf muscle. I mean KILLER. Seems I forgot doing a workout two weeks ago that left my calves out to pasture. I could barely walk when DOMS set in. But after a few days I continued working out. I know. Don’t say it. Already reaping the lovely rewards. I’m taking it easy. Ha! No choice! Ugh…that’s not really funny. After releasing as many calf rocks as I could bear, it’s almost like they released a general soreness throughout my entire calf muscle. Is that normal in your experience, or did I roll over some rocks improperly with the foam thingamajiggy??? My calf wasn’t hurting at all until I squeezed my way to those knots. I’m hoping it’s normal and just part of releasing the knots. I’d appreciate any insight you have to offer. Please keep sharing! I’m learning a lot!
    C…xo

  57. Robert Paredes says:

    Whats the average recovery time for achilles tendonitis?

  58. Suzanne Cosmo says:

    seems I have the injury you are speaking of, except I cannot put my foot flat, I hurt my leg from wearing the new rounded bottom tennis shoes. I cannot walk barefooted, I only feel good in 1, to
    1 1/2 heels. I limp all the time if I am barefooted or try to wear flip flops… I wore a “boot ” for three months via doctors orders and that made it worse.. I rarely wear flat shoes as by the time the day is done, I am a wreck with my hip hurting and my body aches from the limping.. I have the pump bump and it is as tender as can be, and I checked my calf as directed in your video and there is no pain what so ever… I feel like a cripple and am quite unhappy these days… I am 64 and can only walk uphill to my house if my foot is turned to the side since I can not walk with it straight. I would be rushing myself to a doctor, but I have no insurance and no one wants to see me without my bankbook and first born in hand,……any advice? ..

  59. Christobel Ng says:

    Suffer from achilles for a few months and I kept running as they do not bother me that much. I used your trigger points a lot and they helped to relieve my achilles but not completely take them away. I figure I must have not done a good job on trigger point.

    My soleus started to hurt last week. The ART lady I see said that the tight achilles is pulling on the soleus… can this be possible ? Thot its the other way .. that tight calf/soleus pulled the achilles.

    My pain is along the soleus stretch and the inner bone next to soleus ( I do not know what it is call)