Achilles Tendonitis

Achilles Tendonitis is a pain in the Achilles tendon often where it attaches to the heel bone. Another name this injury goes by is Achilles tendinopathy as there is question to whether there is actually inflammation (the ‘itis’) in the injury. Retrocalcaneal bursitis is sometimes diagnosed too, signifying that the bursa sac under the Achilles is inflamed. Then you’ve got names like heel spur, bone spur, and my favorite – the “pump bump” when there is an obvious swelling on the back of the heel. Call it what you like, there’s a problem in the lower leg.

The Achilles is the tendon attachment of the two calf muscles – the gastrocnemius and the soleus. These muscles provide your power when running (especially uphill) and jumping. They are very susceptible to stress as their function is closely related to the adrenal gland organs and cortisol (stress hormone) production. This is why if you’re exercising too much, too often, and too hard, you’ll most likely injure your foot or calf muscles resulting in names like Achilles tendonitis, plantar fasciitis, or shin splints. But remember, it’s more important to diagnose WHY you have a problem rather than exactly WHAT you have. So whether you’re told you have tendonitis, bursitis, or a good ol’ pump bump, it means your calf muscle(s) aren’t working well and you’re biting off more than you can chew.

In the Achilles tendonitis video I show ways to find the trigger points in the calf muscles to help relieve the pain and start to heal the injury in the Achilles tendon. As with any injury, there is some local therapy that needs to take place as well as a resolution to WHY the injury occurred in the first place. Are you wearing the wrong type of shoes? – too high of a heel? – too much support? These types of shoes will weaken your feet and can result in an Achilles problem. Think minimalist footwear and stay barefoot as much as you can to strengthen your feet, lower legs, and entire body. Orthotics? – not a good idea either. They support the foot and lower leg dysfunction.

Excess anaerobic training will soon stress the adrenal glands too much and often result in an injury. Read about exercising aerobically and building a solid aerobic base on the Sock Doc site.

And too much emotional stress can result in injury too. Do you work 60+ hrs a week and are under a lot of stress? See if you’re living an aerobic lifestyle here.

Lastly, the nutritional component is often of utmost importance. Hydrogenated fats, refined sugars, MSG, and other processed foods can all wreak havoc on your health and cause so much stress you’ll end up with an injury. Nutritional problems often set the stage for physical injuries. Read about nutrition here.

Remember, your Achilles tendonitis is an injury that is telling you you’ve overtrained – either on the bike, on the track, in the pool, at home, in the office, or in life.

Comments

  1. Im a runner and have been struggling with AT for over 1year now.
    Recently purchased the trigger point self deep tissue massage products.  Have been using them on my gastrocs and soleus.  How often would you recommend this practice?

    Regards,

    Doug

    • Hi Doug, basically you’re looking to do those just once a day, but more importantly is those points should be improving. So if they are there everyday, and not getting gradually better, then that means the muscles are still under the influence of some other nervous system imbalance, as I mention in the Stop Stretching article. And as I note in the video here, injuries are a 2-part approach. First you have to address why you have the injury (overtraining/stress/diet/footwear/bad habits like stretching). Second you have to treat locally – which means the area around which is injured, typically you want to stay off the actually injury, in this case your Achilles. Hope that helps; that is way too long to have any injury.

      • My recent focus has been on addressing trigger points in my gastrocs and soleus to
        relieve my Achilles issue. Ive gotten modest improvement after 1week.
        Do you have any suggestions with regards to other
        bodily regions/ trigger points that I may need to address to achieve further improvement?
        Or should I limit my focus to the lower leg?

        • Never limit your focus to only the injured area – specifically check out areas of past injuries even though they may no longer bother you – you’ll often be surprised by what you find. So if you had shoulder pain in the past, look for trigger points there and always check out the opposite upper body limb regardless. So if your injury is in the right lower leg, check out the left upper arm.

  2. Thank you for your advice!
    Many folks advocate doing daily ‘heel dips’ on the edge of
    stairs with the emphasis on the eccentric movement during AT rehab.
    Any thoughts on this?

  3. PegLegPete9999 says:

    “Pump Bump Video” I am in my mid 60′s, in April 2010 I wore a new pair of shoes that had an elastic band that rubbed on my heel. I developed a very painful bump on my left heel. I never wore those shoes again. When I asked my family physician about it, he said it was bursitis and to put ice on it; the ice helped but only for a few hours after the treatment. I have not been able to wear any footwear except shoes without heels for a year.
    The bump was very painful and swollen. In December 2010 I started applying an analgesic cream twice a day to the bump. That was the first relief that I had from the injury. Gradually the bump has decreased in size and painfulness, however I still can not wear any style of shoe that touches my heal, even socks with elastic put uncomfortable pressure on the “bump.”
    After watching your video, I am going to start rubbing the back of my calf. In March 2011, I had my right hip replaced, and have recovered from the hip surgery fairly quickly; but my left heel is more stiff and painful than my surgical leg and hip.
    What steps can I take to get my mobility back, and wear a regular shoe? I have seen 2 family doctors at the university and they both have just said it was “bursitis” and offered no real treatment suggestions beyond icing the bump.

    • Hi Pete, I’ve got some info on bursitis at my other site, drgangemi.com, – click here to read it. The other thing that may be beneficial for your heel bump since you’ve had it so long, is cold laser therapy. Some chiropractors and PTs use these. You might ask around and give it a shot if you don’t see any benefit from my bursitis info and rubbing those tender spots on the back of your calf. Good luck!

  4. TriMike says:

    Dear SockDoc, I’m 63 and have been doing Tri events for over 4 yrs now. This year started w/ sprints and last week moved to Olympic. All was pretty good , working on nutritionetc .Waited along time for swim start ,and cold windy (no wet suits). Came out of swim ran 3/4 mile on concrete to transition. Not used to this . Good bike leg but at dismount felt twinge in lt.calcaneus. Still ran but bad feeling. 2days later am in achilles boot to immobilize area.Still about only 30% improvement . Trying to be good. Iused TP roller system for about two yrs on calfs, and ITB good success but this time it sneaked up on me. Orthopod says 3-4 weeks in boot w/ afew NSAIDS now and then,and occassional ice. Your video was like you were in my head. Thanks for that. As soon as the pain subsides more I’m back in the pool. As for the shoes. I’ve always been in the vortex of motion,stability and cushion. Barefoot is out. I live in Florida ,land of the Staph carrying ballistic missile Fireant Army. Minimalist is a very loose term and Tarhumara or Ho Chi Minh sandals are out . Any suggestions? ,Other than “Patience young Jedi” ?

    • 3/4 mi is quite a hike to get to the bike. If you didn’t bruise your calcaneus from the run then you most likely strained some of the Achilles tendon fiber attachments, or some of your plantar fascia. I’m not a strong advocate of immobilizing areas, unless there is a break or some major tendon/muscle/ligament damage (like a tear). NSAIDs are only effective within 48 hours of an injury, at most. If you continue to eat up those NSAIDs you’ll deplete sulfur from your body which you need to build cartilage and break down hormones in your liver. Many time NSAIDs can cause more inflammation too – I discuss this at http://www.drgangemi.com. I suggest you at least walk barefoot around the house and find those trigger points in your low calf (soleus) and maybe even along the bottom of your foot (plantar fascia) and work them out. NSAIDs + immobility = a recipe for further injuries and a delay in this one healing.
      Good luck, “Yoda” :)

  5. Mike’s full of it! Run back to transition was .3mi

  6. Thanks for the informative video! I am 2 weeks out from Ironman and have had Achilles Tedonitis (or Tendonosis, not sure) for almost 5 weeks. This pain is not at the heel, but just above the ankle around the the tendon. My chiro has done some Graston Technique and Active Release. I have gone 2x/week to my Sports Massage for ultrasound and deep tissue work throughout the whole chain (Plantar, calf, Ham). I have also iced it several times a day and I have always used the foam roller, The Stick and Trigger Point daily prior to the injury. I was running 42 miles/week so I quit running except once/week I would go to the track and try 3-5 miles because it was feeling better. It would flare right back up. Even my bike workouts are agitating it. I’m sure that rest is the best thing I can do for it, but I’m trying to determine if it is safe to do Ironman on it in 2 weeks. I would hate for it to rupture. I am scheduling an MRI to try to determine if it’s torn or not. Do you have any other treatment suggestions?

    As for cause, I assume it’s overuse, but not sure. My new Saucony Fast Twitch shoes have less drop, 4mm compared to 10mm on last years model. Some info I’ve read says that less drop can cause my problem and that I should raise my heel with heel cups or orthodics to put less stress on the Achilles. It sounds like you say the opposite so I am confused. I do have sports orthodics because I’m flat-footed, but I wasn’t wearing them prior to the injury. I like the whole minimalist approach to running and even bought the Vibam Five Fingers last year and started doing a couple of miles in them on the grass to let my feet adapt. I haven’t run in them for 3 or 4 months though.

    I am a coached athlete, so my mileage build up was gradual over 5-6 months.

    Sorry this was so lengthy and I appreciate any input you may have.

    Thanks
    Kent

    • Hi Kent – thanks! Tough one to answer here as I don’t know your exact story as to why you have the injury and how you got it – something I figure out and treat on an individual basis in the office. The reason for your Achilles issue, no matter what you want to call it, is often different than another’s. But here are a few thoughts –
      * don’t assume that wearing minimalist shoes or going barefoot means you won’t get injured. That’s only part of the equation. You can still overtrain, or be under too much overall stress, and get injured.
      * less shoe drop or zero-drop doesn’t cause an injury unless you converted from a high heel too quickly. Muscle imbalances in the foot and lower leg can and will do that. Raising your heel or wearing orthotics might change your gait and shift stress – as I discuss in the post about orthotics – but they won’t help correct the problem. They just move it around. I talk about the “flat footed” on this site – basically whether you were born that way or became that way doesn’t mean you should wear orthotics. Actually I think the opposite.
      * your MRI isn’t going to influence your decision to race or not – it shouldn’t anyway. If it isn’t actually torn doesn’t mean you have the green light. 2 weeks out to the race isn’t much. You’re well into taper-mode and should only be doing short speed and recovery workouts to rest up and keep your fitness now. You can’t even run a few miles w/o pain or ride the bike, so hear what you’re saying and be smart about it. IM races will always be around. If you really mess up your foot more than it already is best case scenario is only the rest of this season is lost – you’ll spend the whole summer recovering.
      * I’d say you overtrained – so look there – your training HR, overall stress in life, diet, etc…

      Good luck!
      SD

  7. got a tough one for you…three years hobbled by achilles tendinosis(?). MRI two years ago said there were microtears and bone spur – but not surgical problem. Have had physical therapy, graston, ultrasound, did a lot of icing early on, had cold laser therapy and recently tried a PRP injection. Also have tried the eccentric heel drop regimen for a few weeks at a time. (Is that technique supposed to aggravate the pain for a while before it gets better? Maybe I didn’t stick with it long enough) Not sure what to do next. Think the problem started with power-walking to and from work everyday – every step hurts. Was there something in there I should’ve stuck with long? Some combination of things? Should I have night-splinted or gotten a walking boot for a few weeks to shut the area down? I always walk with a limp. Can’t run. Can’t walk a mile without calf stiffening up on me even. Would hate to get surgery – up for anything. Would love your advice.

    • Hi Barry, yeah that’s tough, especially by email, this is more of individual diagnosis/treatment that would be more specific to what is going on with you. Check out the various articles under the “Injuries” tab, they will hopefully shed some light on the matter. Sounds like you may need a doc who can help you out personally. Definitely no night-splints though, and you shouldn’t get worse before you improve.

  8. Jean-Serge Cardinal says:

    Hello,
    I have pain where the Achilles tendon attaches to the heel bone on my right foot. There’s no inflammation but pain built up if I run more than 2K per day. For example yesterday I run 8K and today it hurts. I could probably run another 8K today but then it would get worst. If I rest for two days then there’s no pain at all. It’s like that since September when I ran my second marathon. I did the first half in 1h37 but the second half I had to walk, the pain was too severe. Maybe the injury got worst during that race. The injury started when I switch to minimalist shoes in July with no adaptation period. The pain gradually increased until the marathon. After the marathon I did more bike than run but the injury never healed. I’m 46, I’m training since 1997 and had a lot of injuries but I never had this one before. When I run with normal shoes it’s better than with my minimalist shoes. Should I stop running completely for some time?

    • Hi Jean-Serge. The video here on AT should help. You must have some very deep trigger points that need to be worked out in the calf muscles. Since “you’ve had a lot of injuries” since 1997 you’re doing something that is not quite working for you. Remember injuries are often diet related, as I discuss on this site, or from training too much too often (or lack of rest) as well as improper footwear.

      Since this injury started from going to minimalist shoes it is most likely because over time, wearing typical running shoes causes your calves and Achilles to shorten – so when you go to a more minimalist and barefoot gait, it takes time for this to adapt. I would recommend you perhaps consider going back to your other shoes – unless they are very over supportive with too thick of a heel. If they are, find a good transitional shoe – Nike Free may work, or the NB minimus road (not trail – that is a more minimalist shoe)…check out our review here at NRC http://naturalrunningcenter.com/shoe-reviews/?viewby=types&val=Neutral/Transition. Then, either walk as much as possible in your bare feet or in a zero-drop shoes while eventually weaning off the transitional shoes as you heal and better adapt.

      • Jean-Serge Cardinal says:

        Thanks a lot for your reply

        All my past injuries were due to overtraining, I need more discipline to stop running. I’m 80% vegetarian, with a bit of chicken and fish, rarely red meat. But I noticed something I was doing wrong when I watched your video on this topic, stretching the injury. Then I realised that the day after my stretching session it’s always worst even if I didn’t run the day before. I’m not sure if stretching is a good thing for me at all, so far it only gave me trouble. I can’t imagine our ancestors doing a stretching session after running all day after their food. Therefore I’ll stop the stretching and try to go back to running gradually. I won’t go back to minimalist until my tendon is solid. I’ll post again in a month or two to follow up.
        Thanks again.

        • You’re welcome. If you haven’t read the Stop Stretching! post then you should. Also the GAGs post as hopefully that will convince you not to be a vegetarian.

          • Jean-Serge Cardinal says:

            Hi again, here’s a follow up that I think you’ll find interesting. In winter 2012 I saw a physio therapist on a regular basis. Basically calf raise with a 5day/week progressive training program. (No trigger point massage). Every time I reach the 5km run I re-injured. Finally I dump the physio and the calf raise and the 5day/week program and went with a progressive training every two day and the insertional Achilles problem was solved in 3 weeks. Later I found out in the literature that eccentric calf raise doesn’t work so well for insertional Achilles problems.

            Anyway After 6 weeks I started running with minimalist sandals at about 70km/week then I got a stress fracture on my left foot. 3 months of total rest. Again to much to soon, doesn’t listen to body signs ect… Don’t hit me I suffered enough.

            I resume running in the fall and winter 2013. I was at a steady 40km/week for 3 months and out of no where I started having midpoint achilles pain. I started calf raise and It went insertional and I couldn’t run a mile anymore.
            I’m still struggling with this injury, I can’t go more than 30km/week. But by reading your text again today I realized that the pump bump behing my heel is caused by my working shoes (Vivobarefoot RA), not by running. is it possible that this is the root cause of this injury? It’s like if my working shoes is applying pressure on the tendon and prevent it from curing. I have those shoes since fall 2012 which explains why this time I can’t recover from this injury.

          • Hard to say. Sorta the chicken or egg scenario there. But something is not right. Typically something like this there are old injuries still causing imbalances and affecting gait.

  9. Randy Hohf says:

    Dear SockDoc,

    Read the No Stretching article and watched the AT video. Thanks for those. I’m 56 years old, been active all my life. Been struggling with Achilles Tendonitis on and off for about 8 mths, but it also hurts at times on top of the ankle (opposite the AT), sometimes along the side, and at times across the length of the bottom of my foot. I think it is all related to AT, though I did sprain my ankle skiing just over a year ago. I Telemark ski weekly, but only one run each time after skinning (hiking with skins on skis) up the mountain first (very steep hike up). I play/coach/ref hockey, and so this winter was on skates about 5 or 6 days a week. I ride bike, hike and climb mountains and rock climb in summer. I don’t run much, but I think my problem is related to overtraining or overuse at least. I eat pretty well, so not sure if nutrition is an affect, but possibly.

    Anyway, I give it a rest for a few days or week, but then it flares up again when I ski or play hockey. Been getting some Ultra Sound a few days a week and icing it daily. Just started (today) doing deep calf massages myself as per your video. Any other suggestions? I can usually walk fine. Been using orthotics but going to try to take them out. How long should I let it rest before exercising it or returning to more active regimen?

    And why do I get pain on top of ankle or bottom of foot?

    • Hi Randy – don’t get too concerned with “what else to do” because you have two important things already to do that you just started – the deep trigger points and weaning off the orthotics. You’re getting pain in the ankle/foot because your tendons, muscles, and ligaments aren’t working correctly which could be for various reasons as I discuss in the video, but orthotics will play a part – usually a large part. Start by walking barefoot as much as you can and work yourself out of the orthotics as quickly and as comfortably as you can. Then you slowly introduce the exercise as long as you don’t have pain, though you may have some mild discomfort as you’re using those muscles, etc that you haven’t for so long because you’ve been supporting/bracing them with the orthotics.

  10. Hello doc,

    I’m 23 years old and for 3 years I’ve played indoor soccer or Futsal as a hobby, 3 times a week (Tuesday, Friday, Sunday), 2 hours a session, usually a warm up jog before and cool down stretches after. Sometimes I play on pavements and astro turfs too.

    It was 2 months ago, when i first felt that there was something wrong with my right achilles tendon. I would describe the pain as like having a small sharp rock stuck in the heel liner of your shoes (behind the achilles tendon).

    From that moment until now, I have carried on with my weekly futsal routine. The pain could be felt only at the beginning (when I put on my shoes) and ending of each game.However it wasn’t the same case when walking or when taking my first step every morning, there is only the feeling of tightness around the heel and achilles (this remains constant from the beginning of injury until now).

    There is also a small lump on my achilles tendon (about 5 cm above the heel) at the moment, although I hardly remember when it first developed (maybe 1 month after injury). I also notice that the pain had started to subside gradually since roughly 2 weeks ago.

    I’ve just discovered your website therefore I’m still confused about the progress and the cause of my injury. I had shin splints, tight calf and tight hamstrings before. Although I do stretches to “overcome” these, I’ve never directly or routinely stretched my achilles tendon from the start of the injury. I only apply ice several times a week. I don’t wear orthotics either. I visited a doctor once (not a specialist though) who said it’s a mild injury but I’m still not convinced.

    I would also like to know if I’m going at the right direction with this new Nike Futsal shoes i bought, which has this cushioning sole technology called “Lunarlon” (commonly used in Nike’s running shoes). I bought a us size 9 which leaves little space around the toe area. Do you consider this as an orthotic shoes? http://www.studs-up.com/2010/12/studs-up-mega-review-nike5-lunar-gato/

    Could my previous shoes be the culprit? My old shoes was an 8.5 us with a low sole profile, really snug with almost no space left in front of my toes. All of my other older shoes shares the same characteristics.

    I don’t give 100% each game but I’m growing anxious of the possibility of rupturing my tendon every day. I’m aware that the main cause could be overuse. Is my tendon getting better? How can a pro athlete under a proper physio supervision still ruptures his achilles tendon? I believe my main concern is how hard can I go until I could possibly rupture my tendon?

    Sorry if my questions seem lengthy and redundant..I haven’t caught up with all the comments and posts here.

    • Hi Paul – I’ll try to address some of your questions here. 1) Shoes could definitely be a problem. As you know from reading my material here on the SD site, they often are either part of the reason or the entire reason for an injury, including Achilles Tendonitis. But it could also be from training too hard, improper diet, other stress in life. 2) Yes those shoes personally I would not wear. But if your body is used to non-minimalist type footwear then you will slowly have to work out of them as I discuss in the recent post: “Healthy People = Barefoot People“. 3) Don’t think a “specialist” is anything special. Sorry, they’re not. These docs specialize in a particular area of the body when it comes to one thing – surgery. If you want to know WHY you have an injury and how to really address it, they don’t have a clue, because they don’t specialize in the whole body and the knowledge that one thing affects another. They’re isolation specialists. 4) The reason why professional athletes under direct medical and physio care still have injuries is because they also only look at the area where the body is injured. They also think stretching, orthotics, and ice are ideal therapies while diet and footwear doesn’t contribute to injuries.

  11. Gianfranco Santaliz says:

    Hi Doc,

    I had AT three weeks ago after going hard on uphill courses two consecutive days (great mistake). After that I found SockDoc via NRC and rested for a week along with ice baths and compression. The pain left, and I started training. This past two weeks I have run without pain but I still feel some stiffness, and when I do squats with heels on the floor I feel something pooping in the tendon area.

    Should I rest or continue running?

    • You should train easy and listen to your body – achy is okay, sharp pain is not. I don’t recommend ice baths for AT, and I also don’t often recommend compression but specific trigger points. Remember that AT is most often because you’re dealing with too much stress – training, diet, life.

  12. runnerjt says:

    Hi Doctor.
    I am a 34 year old male who runs about 30 miles a week and finished my third marathon a week and a half ago. I had very achy Achilles for last bit of the run and into my recovery week (under training and overexertion were the cause, I am almost sure), but after rest and some very painful trigger point manipulation, I can run a few miles without too much discomfort. However I think all the stress may have enlarged the “pump bump” on my right heel. I think that is what it is; looks much like yours in the video. There is no pain or noticeable swelling back there but now it is rubbing the heck out of the heel cup in my shoe. It is at the point where my heel is abraded and raw (almost bleeding) after only 3.5 miles. I have 82 miles on these shoes (Mizuno Mushas) and have not had this level of rubbing before. I do have holes in the heels of all my shoes from the bump, but have not had this level of trouble in years. So…
    Do you think it is related to the overworked calves/Achilles and if so will it get better with rest? i.e. Reduce in size so it does not rub so much. Or did I do lasting damage, and have to start the hunt for shoes that do not aggravate the bump as much? Also, in the past, I have cut the offending area out of the shoe to gain relief. Is this a viable option?
    I know you might just say, “go barefoot and you would not have to deal with all this,” but I am not quite ready for that yet. I do have a pair of Merrill Trail Gloves that I have tried to transition into, but they just feel wonky on my feet and just kill my Achilles at this point. I am thinking about going for the vivobarefoot trail shoes, but until then, I do not want to curb my running too much, so I am thinking cutting out the heel might be my best sort-term option. Any input or insights you can share would be greatly appreciated.
    Thanks for reading and for your super-informative and thought provoking site.
    jt

    • If you just created the pump bump from the recent race then yes you have a very good chance of it returning to normal with rest and some deep trigger point work. The longer you have it the more likely it will calcify and stay. If it’s really bothering you running (scuffing your shoes) then yeah you can cut a hole. Mine never bothers me in any shoes – walking or running. I don’t think you necessarily need to run barefoot but obviously easier on the heel problem than with any shoes.

      So no more overtraining, right?!

  13. I came from the orthopedic specialist with AT diagnosis. I’ve had pains for a year and more. I am a bit confuse off all information that my doctor gave me and all about I read on the web. I was a track a field runner when I was young – I ran up to 400 m, even hurdles, sometimes practices a long jump. I always run on external front part of my foot; I never land on my heel, what a doctor suggested me (?!?). I like run barefoot, on the grass surfaces, from my childhood. But when I did now (I am 50 years old), I have a huge pains. Not during my run but during the night and days along. The same happened when I went with Merrel barefoot shoes. I ran only some hundred meters (on hard surface – a street), enjoying a lot, but not sleeping during the night because of the AT pain. I read about stretching, I saw suggestions int his movie http://www.youtube.com/watch?v=PJPfzTHpbAM&feature=relmfu and I really don’t know whom to believe and what to do. I wake up in the morning with a huge pain in my foot, making some exercises – moving my foot up and down, left and right and with a lot of pain doing my first steps. What I read until now I connect my AT difficulties with sciatica problem and tensions in my calf. Do you have any reasonable suggestion to me? I would like to come back, running on the streets, running up and down and feeling free of pain.

    p.s. sorry for my English, it is not my mother tongue.

    • The ‘reasonable suggestions’ for you are all on this site, specifically the AT post/video. Yes, my information is “conflicting” in regards to mainstream medical. But you’re following their advice, and you’re still injured and in pain.

  14. John Calarco says:

    Hey sock doc I was wondering what your opinion was on an achilles sprain? I actually sprained my atfl, peroneal, and achilles. Its been 4 months and the peroneal is minimally sore and the front of my ankle has no pain but my achilles is being stubborn and will not heal up. Is 4 months normal for an achilles sprain could it be something more that I need an MRI to see? it had gotten progressively better and was feeling pretty good until i did some running and jumping on it then the next morning I woke up and it was stiff and restricted again. Its worth noting that I have been a follower of your site for probabaly a year now and I follow most of the stuff you reccomend like no stretching, my sleep cycles are consistent and i sleep through the night, I have a deep understanding of nutrition and have followed a paleo type diet for a long time, Basically i think im doing everything right and cant understand how i could still have any pain in my foot. I constantly have PT’s telling me to just wear an aknle brace because my ATFL is probably so stretched out from the sprain that the achilles is compensating? Is that even realisitic? Would love to hear any thoughts you have.

    • Achilles problems can take a while to heal up because they’re always working hard to support the feet and calf muscles. Plus, any imbalance in the foot or lower leg will often cause distress on the tendon. I doubt that it is “stretched out”; look for those trigger points in the calves. If you’re still having pain then they’re there somewhere.

  15. Greetings Doctor,

    I read your articles regarding to Achilles tendonitis and saw the video as well as the one related to trigger points and knee pain. All very good stuff, keep up to good work!

    I wanted to ask you how long does Achilles tendonitis last?
    I started to play soccer quite heavily recently (last 9-12 months) and there has been a residual pain in my lower Achilles region. I am 23 and play for a collegiate team. Main symptom is discomfort/pain in the early warms ups then pain immediately upon completion of training. More troublesome is I can sometimes feel an almost literal tearing sensation at the bottom of my heel. This is the same when I go for a run on the sidewalk/road as well as treadmill. What do you think my options are here?

    Your view and practice is nontraditional and is a welcome sight to the common generic diagnosis’ of the complacent doctor. Your opinion would be greatly valued, please let me know, best.

    • Hi Aaron, it all depends on two things – the severity of the problem and what is causing it. For example, if it’s a minor Achilles strain and from say, improper footwear, then it’s a quick fix; but if it’s from overtraining and a significant strain, then it could last a long, long time (like yours is).

      So right now you try the things I recommend and see where it gets you. Consider that you’re pushing yourself too hard since it happened when you started training hard. Other than that, you look for a nontraditional doc/therapist who looks at the entire body to perhaps help you out; of course there is always the medical route, but in my experience that is only necessary if you actually need surgical repair but you’re not there and hopefully won’t get there – don’t let the AT get any worse!

      • Thanks Doctor, I will try and rest it more.
        Also, I’ll try and get my hands on a massage roller, seems handy.
        Best.

  16. Doc I need help! Im a female 5’0 im little but I have been doing calf lifts on a machine at a gym. Recently I have added a little more weight than needed, but anyway I have this pain on the top left of my foot that only bothers me if I move my ankle if I roll my ankle up and towards the right, as well as when I move my foot to the top left. At one point when I was moving my ankle around to see how it hurts, it kinda made my achilles tendon feel some pain as well. I have rubbed the top left of my foot/ankle in the hopes it would help but it just stays the same. Its not too painful, but I dont want it to cause further injury. What do I do?

  17. Dr. Mark Horowitz DPM ABPOPPM CSCS says:

    Came across this web site resulting from a search for reviews on zero drop running shoes. I am a retired Podiatrist (formerly Board certified in Podiatric Orthopedics and Primary Care Medicine, and a Certified Strength and Conditioning Coach) and an admitted curmudgeon/misanthrope. I have not performed more than a cursory review of this website, but assume the practitioner has a disclaimer advising readers that it is impossible to responsibly offer treatment advice, let alone proffer a diagnosis based upon a written subjective description of symptoms, history, and previous attempts to treat. That being said, I would like to comment on several points that struck me to my cynics core.
    Dr. Gangemi offers rather scathing comments about what he terms “isolation specialists” inferring a “blinder mentality” that he wrongly attributes to all specialists, but IS characteristic of an inept practitioner regardless of their specialty, yes even Chiropractors. He claims that “The reason why professional athletes under direct medical and physio care still have injuries is because they also only look at the area where the body is injured. They also think stretching, orthotics, and ice is ideal therapies while diet and footwear doesn’t contribute to injuries.” From this I assume Dr. Gangemi is claiming that his regimen of treatment would prevent reinjury among professional athletes? Has Dr Gangemi ever met a Podiatrist who did not believe that inappropriate foot wear can be a causative factor producing Injury? Apparently he has little interaction with other medical professionals.
    To dismiss entire fields of health care as fraudulent and short sighted is patently absurd.
    A responsible, well trained, ethical Podiatrist is acutely aware that there are systemic conditions that present with localized symptoms that are not amenable to Podiatric care. I would offer that a well trained Podiatrist has more in-depth training, and a better understanding of the biomechanics of the entire lower extremity than most Chiropractic graduates, and are well versed in the functional interaction between segments.
    I cannot comment intelligently on the minimalist running trend, as, to my knowledge it was not in vogue among my patient population as of 2005. I can comment on popular trends in sports medicine and fitness over the past 30 years, and often as quickly as adherents flock to the latest innovation, kinks in the ideologues armor (injuries) concerning their supposed panacea start showing up in their neighboring physician’s offices. Youth and the resilience of soft tissue and the human body are often forgiving of inappropriate training regimens. Biomechanical faults stemming from boney abnormalities (i.e.genu varum, genu varus, forefoot to rear foot abnormalities) will not be corrected as a result of natural running. It is the rare human body that functions without biomechanical faults, and while inappropriate footwear, poor technique and ill advised training regimens certainly cause injuries, barefoot running, diet, positive thinking, and worshipping the Greek pantheon will do little to address an injured female runners Q angle.
    The zero drop running shoes sound interesting in theory. I fear that a large segment of the population, in particular middle aged professional women accustomed to high heels will not have the gastroc flexibility to accommodate to these shoes without first regaining sufficient flexibility to drop their heels to the floor. If zero drop becomes popular among those with tight gastroc’s there will likely be a plethora of lower extremity injuries.
    Practitioners who marry themselves to one theory to explain every patients symptoms, dismissing all other treatment and diagnostic modalities as part of some conspiracy theory between medical practitioners and some monolithic medical-pharmaceutical complex do a disservice to their patients. Holistic zealots are as dangerous as surgical, orthotic or physical therapy zealots. I doubt that Achilles pain secondary to a systemic inflammatory disease would be amenable to minimalist running. A reasoning well intentioned medical practitioner follows a problem solving algorithm, first establishing an ordered list of differential diagnoses not prejudiced by dogma which draws a conclusion first and proceeds to find evidence to support that conclusion.

    • Hi Doc, I’ll make a few comments regarding your comment post here since you took the time to write it.

      * There is a lot of info on this site. It’s a different philosophy than most are taught, whether on their own or in school – and I’m referring to all doctors, your education or mine. I don’t single out podiatrists other than the fact that they prescribe orthotics a lot. Though chiropractors and PTs do too, and I note that. Of course I’m against orthotics for the many reasons mentioned (in other articles). You should not take anything on this site “personally”. If you do, it’s probably because you were one of the docs who looked outside the box, or in this case, the foot. Most podiatrists just look at the foot just like most chiropractors look at the spine, but of course there are exceptions.

      * Regarding your comment that I have “little interaction with other medical professionals” – again you would hopefully not say this if you read more of this site; you’re making an assumption there without asking or investigating more. There are comments from other DPMs who I closely know and consult with and MDs, PTs, and DCs too. And since I’m an advisor over at the Natural Running Center there are even more docs there that I work with and we all share a similar philosophy.

      * Do most doctors think that diet does not contribute to injuries? I’d say definitely yes. Actually most docs don’t think diet even relates to any disease. And I know this first hand seeing many patients who see doctors at Duke and UNC. Do a lot of docs think that footwear doesn’t relate to injuries? I’d say that more think “more is better” meaning more support, more motion control, and more heel help prevent or heal injuries. Of course, as you know, I feel the opposite. And do I think that my regimen of treatment prevents injury and reinjury? Definitely. I can say this because that’s what I see – and yes I see professional athletes and many Division I collegiate athletes. You can read just a few of the testimonials on this site (linked from the home page). They’re all real patients and coaches.

      * Regarding the “minimalist running trend” that is something that I’d rather not get too deep into here because basically it comes down to that those who think it is just a “trend” will continue to think that way and that humans were never meant to walk, stand, or run barefoot. I don’t feel it’s a new trend, but one that is being brought back or re-investigated you may say, since we used to be a shoe-less society hundreds of thousands of years ago. Though life has changed drastically, we have not to the point where we need shoes (at least most of the time). Though as I explain in the article “Healthy People = Barefoot People” many people feel the need for support because their health is so poor. Can diet and exercise change something like a Q angle? Probably not. And there’s no place I say it does. But I see many injured with structural asymmetries or such Q angles and I’m able to resolve their injuries even though that angle doesn’t change much, or at all. I have my hands on people all day long and I follow a system of diagnosing processes and figuring out the best way to resolve them. And it’s working pretty well for me. I’d say that I’m a “reasoning well intentioned practitioner” as you note.

      And yes, the disclaimer you ask of is on every page, and no specific individualized diagnosis or treatment advice is given to those who ask. I give general advice on things to try, things to investigate, questions to ask, and how to self assess one’s problem or concern so they can heal on their own or find someone to help them along that path.

      • Mark,
        I am a Family Physician (Professor WVU School of Medicine) and like most who collaborate and share ideas with Steve, a passionate advocate for holistic health and wellness. We are all trying our best to cross disciplines and learn and collaborate with each other. I continue to learn daily. I am in one of the most obese states in the country and have beed advising (insisting) that patients with the whole spectrum of metabolic dysfunction, esp type 2 DM, to get off all the simple sugars and processed stuff. As simple and ridiculous as it seems….if you do not eat sugar you do not need more insulin to lower it. Patients immediately drop their meds and feel better! all the inflammatory effects are mitigated also, esp CAD, HTN, and hyperlipidemia.

        I learned most of this from folks in exercise science- Tim Noakes, Phil Maffetone, and obesity expert Dr. Robert Lustig. see the great video series here http://www.uctv.tv/skinny-on-obesity/

        I also advocate for reducing the shoe and strengthening the foot. i have an extrem Q angle. i was one of the kids who was braced for intoeing. luckily this practice is now abandoned. after patellat tendon reattachments and the myriad of other injuries i now run pain free barefoot and occasionally jump into marathons (and hang with the young folks).

        Steve thank you for sharing your experience and wisdom

        Mark Cucuzzella MD

  18. Hi Dr. Horowitz,
    When I graduated from PCPM(Temple)in 1995, I was awarded a scholarship for being the graduating senior with the greatest understanding of, and proficiency in fabricating custom orthotics. This is because I largely lived in the gait and orthotics labs, when I wasn’t in class. I spent countless hours with the biomechanics greats; Hillstrom, Palamarchuk, Whitney, and others.
    When I graduated, I moved back to the West Coast and took a consulting position with Superfeet footbeds/NW Podiatric Labs. They hired me to enhance their educational program, and to help teach adult Americans how to take care of their feet and legs.
    During my research for that position, I encountered the writings of our own William Rossi, DPM, in Podiatry Management magazine in 1999. “Why shoes make normal gait impossible”. You can view this article and 3 others by Dr. Rossi, on my website http://www.nwfootankle.com. Dr. Rossi challenged the current podiatric paradigm, by clearly demonstrating that the most likely biomechanical faults to be found in humans, were not those we were trained to measure in our static biomechanical exams (forefoot to rearfoot relationships,etc.), but were those caused by elevating heels above forefeet, toes above metatarsal heads, and squeezing toes of feet to be narrower than the ball.
    Dr. Rossi stated most podiatrists will look for biomechanical problems within their patients bodies as cause for dysfunction, but have little, to no, awareness of how every shoe they have been wearing since infancy has directly influenced, or completely created the dysfunction/injury.
    Minimal footwear has covered the feet of humans for most of history. It is only within the last 30 years that the footwear currently recommended by most podiatrists, and podiatry groups, has been in vogue. By this I mean pronation control, elevated, cushioned heeled running shoes. Prior to that, all athletic footwear was minimal.
    Yet, somehow most podiatrists want to cling to their deeply conditioned belief system, while their armor is disintegrating around them, and the rest of the medical community is wondering why they can’t see the fad they blindly endorsed, and let it go.
    I can speak to the value of minimal/natural footwear, as I have used this type of footwear with my patients since 1999. When I get my patients out of fad footwear, and custom orthotics, they really do well. Some of my patients represented our country in the recent Olympic games, and one won gold! Those athletes sought me out for the same reason athletes work with Dr. Gangemi. We prevent injuries with natural footwear, diet, etc.
    We evaluate them thoroughly, but are not looking for reasons to immobilize them or intervene on them based on measurements of theoretical values. We believe in them and the ability of their bodies, if properly conditioned/nourished/rested/etc. Footwear that allows a foot to function naturally is a large part of our program.
    Since you are retired, and believe minimal footwear is a fad, I am interested in why you are researching zero drop shoes?
    If you would like to visit my clinic, or speak by phone, I would be happy to accommodate you Dr. Horowitz.
    Ray McClanahan, DPM

  19. I am an acupuncturist and flamenco dancer. Recently, after rehearsing, and after 2 slightly L sprained ankles from Dansko shoes in past 2 months, I have developed a click in my ankle and now very sore AT. After rehearsing cannot bear much weight without pain and am limping to protect L side. Also feel like I have slight PF on bottom of L foot. I am supposed to perform this Friday night (in 3 days) and afraid achilles tendon will snap. Should I pull out of show? Can I continue to rehearse with rest in between rehearsals? Ice? Heat? The L achilles tendon feels very thin compared to R side. I did massage the L calf which feels better but ankle still bothers me. Achilles feels very weak. I don’t want to risk a snap and need surgery. Any way you can get back to me right away to guide me in making the decision to see if I can find a replacement for the show? Thanks. Jess

    • Hi Jess – I’d love to tell you exactly what to do but I can’t do that via the internet. I’d have to evaluate that and see exactly what is going on, and why, to determine if you’re stable enough to get through the show. When in doubt, you bail. Not worth the risk of creating significant damage and ending your season for a prolonged period or maybe permanently.

  20. Firstly, I apologize for my bad english … I write from Italy
    I recently discovered your site interesting and I am very attracted to minimalist shoes.
    I saw your graphics on the shoes on accident and I have a big doubt.
    I suffer from Achilles tendinopathy for many years and nobody has ever mitigated the traditional shoe hate that I feel at the beginning and at the end of my workouts.
    I am an amateur runner who runs about 40 km. to a weekly average of about 5 minutes per kilometer, weight 74 kg.
    What I want to know is if I can take my illness, little by little, the way to use minimalist shoes or there are scientific reasons in my case I do not recommend its use.
    I wonder if the risk of worsening the condition of my Achilles tendon.
    Thank you for your attention.
    sincerely

    • Hi Roberto – tenderness in the low calf and Achilles area is common when someone is transitioning to minimalist shoes and barefoot running. It is, for the most part, normal as the Achilles has shortened from wearing traditional shoes for a long time. So if you suffer from AT, then you either need to let that heal up first or at least proceed more cautiously.
      Check out this article too: http://sock-doc.com/2012/03/healthy-people-barefoot-people/

      • Hi Doc !
        I’m sorry for my bad English, I hope will understand what I am writing …
        just today I made ​​an echography Achilles tendon
        “Mild inhomogeneity of the distal third echostructural mainly in the pre-insertional where observed sporadic micro-calcifications. no Peritendinous effusion”
        The radiologist was very young (how much experience you can have?), Told me that there is no payment, no inflammation, no injuries, which we can not speak of tendinosis (also considering that I “only” 37 years …): in short, he painted a reassuring picture
        What do you think? What should I do? I can safely continue my gradual transition to “minimalism”?
        Thank you!

  21. Happy to have come across your video and site. I’m a holistic health coach, so always pleased to find a kindred spirit to refer people to. I’m also a recreational runner. Unfortunately, I happen to be a runner with AT at the moment. It started a few months ago. I believe it came about from a few things — opting to do a hillier run to avoid traffic (after 5 months…I think it created some wear), some significant changes to routine, and some interruption to my yoga practice for weeks here and there during the summer. I also thought it was due to only wearing flip flops and walking around barefoot…but from your outlook, that should have helped? I run 6 miles / 5x a week, and also do about 6 hours of yoga a week.

    So a few questions. I have tried various things to correct the problem (reducing my runs, doing flat runs, eccentric lifts, ice, insoles), but not focusing on the calf and connection to the achilles, so that’s my next up. Am wondering if the following insoles are what you mean by “orthotics”. I got them on the advice of my running experts:

    http://www.superfeet.com/products/Green.aspx

    Should I take these out of my running shoes? They are only meant to align my foot, but do also provide some shock absorption in the heel. I run in a light, rigid, neutral shoe, though not a minimalist. Also have worn out shoes that I could run in. Would that be a better option? Not sure I’m quite ready for minimalist. I run outdoors year round in NYC…so not sure how well they’d work given weather and road conditions around here.

    Also wondering about the yoga. It may not be about stretching, but it does in effect cause me to stretch. As a runner I love it for my hamstrings. Is there anything in particular I should avoid or focus on in my yoga practice given my AT issue?

    Thanks for your help!

    Judith

    • I am familiar with SuperFeet and yes I consider them an orthotic and would not recommend them. You don’t want a device to align your foot, as that alters your gait. And you can’t absorb shock in the heel – even if you’re a heavy heel striker (doesn’t sound like you are). That’s a huge myth – you absorb shock though the arch and by normal pronation, all which will be altered if you wear thick shoes or a device that absorbs shock.

      Yoga is fine as long as you keep it within your means. If you’re trying to get into a pose and are holding it uncomfortably via stretching rather than activating the proper muscles, that’s a problem.

      • Thanks very much! That’s very clear. Good advice on the yoga, and a nice distinction between stretching and actually doing the pose. You’re right, I’m not a heel striker. The opposite. I’ll try your suggestions and see how things go. Hoping for a speedier recovery than the usual AT protocols seem to provide.

  22. Hi, I have been suffering for a year +++ now with a bone spur on my heel which affects my achilles tendon. The area around the bottom of the achilles has a bump but extends around to the area below the ankle joint and it is swollen 24/7. It has been very painful and I have had the area xrayed which showed a heel spur aggrevating my achilles according to my doctors analysis. i am wondering what I can do to reduce the swelling and pain. I have applied ice, pain relief aspirin and stretching. What would you recommend? I have reviewed your video and would like some feedback. I have found your website to be very informative and helpful. Thanks,

    Rob

  23. Hi doc,, I am 52 years old and not in bad shap, I decided to join a softball team which may not have been a great idea.. I was running to make a play and twisted to turn, I immediated ly felt a ripping feeling in my left calf and went to the ground. Well that was it, I got some ice on it immediateddly and was able to move all my toes and angle , but I could not put any weight on the foot. Do to my life I cann not stay off my feet to much and it is now need 5 weeks Since the accident The swelling I’d almost gone but I still have pain wel I go down stairs or get on my toes,, I also developed a pain in my heel. I gues from trying not to put wiegh on my toes.. Any ideas what I can do to get ride of this.. I walk with a noticing e limp at this point and it is extremely anoying..

    Thanks for any advise

    • Follow the advice I show in the AT video – the deep trigger points. They’ll be deep and painful but you need to (or get someone to) get in there and work them out.

  24. Hey Doc, I wrote to you about a month ago asking questions about my achilles tendonitis issues. Things have gotten a lot better since then, and the issue I am dealing with now is that I am extremely nervous to go for a run and test out my achilles; I dont want to aggravate it all over again. For about 7-9 days now I haven’t felt much pain at all, (any pain was real minimal and short lived) the only thing I have been feeling is slight achiness every now and then, and just that weird feeling that something was/is a little off. My question is where should I go from here? Am I being to careful and almost making myself paranoid that it isn’t healed yet, or is the way Im feeling perfectly normal and that the tendonitis is gone and I can SLOWLY get back to running?

    Thanks in advance!

    • Hard to say since I can’t see it. But the only way you’ll know is to test it. Take it slow and work the trigger points out, if any are left, before and after the (easy) run.

  25. Hi im really confused. everything that you say contradicts what I have been told to do by physiotherapist. I have suffered from chronic Achilles tendonitis for 3 years now and im only 20 years old. I did everything my physiotherapist asked me to at the beginning but as time went on they gave me more and more stretches to do. Recently I havnt been exercising properly so im back to square one. however when I did do the stretches my physiotherapist told me to I did notice an improvement.

    Is the advice you give only for people with acute Achilles tendonitis? I wear orthotics everyday as I find I cant walk for very long without being in pain and I have began stretching again. however im concerned as you completely contradict everything my physiotherapist has told me. is there any hope for me? can I recover? also the pain has spread from my lower leg to my thighs does this mean im stuck with this condition forever?

    • Yeah it does contradict. But look how well you’ve done with the “non-contradicting” advice.

      This is info for anyone with acute or chronic AT. I can’t give you specific advice but at which point will you say to yourself “maybe I should look elsewhere after 3 years”?

  26. I am now going on my second year with AT, or so I think that what it is. I played indoor soccer over the winter and there was no issue with my Achilles but as soon as I hit the outdoor field it was instant tightness..I stretch and jog before I play but I find it odd that it started immediately when I hit the outdoor field….your thoughts Sock doc?

  27. When i put ice on my achillis tendon it hurts.I had a surgery to repair it&am on my 2nd month of rehab now.

  28. Hi Doc

    Wish I’d found this site earlier! I damaged my Achilles through overuse around 4 months ago. I took a complete break from running for 10 weeks and since then have just kept ticking over with 1 or 2 short, easy runs a week on top of my usual ironman training schedule bike and swims.

    So…ironman is this Sunday…I’m confident I’ll get through the ‘run’ with a combination of jogging and walking but wondered whether taping would be a good idea. It’s pretty inflamed at the moment after the weekend’s run and I want to minimise longer-term damage.

    Thanks for your help!

    Si

    • That’s your call. Do what you can do to get through it ONLY if you know you’re not creating permanent or prolonged damage. It’s not going to feel good if you finish the race after a death-walk marathon and you can’t run for the next 6-12 months.

  29. Dear Doctor.First of all thanks for your support.I have AT for almost 16 months.I made a blood test and it turns out that my blood is completely healthy and no sign of inflammation was spotted, also I made an X-ray, and it appears that I have no heel spur, and my Doctor told me that my muscle feels completely healthy……I didn’t get injury of my ahill tendon, I don’t run, don’t practice heavy training ect.Presumably it was caused by long standing in one place,I’m auditor and when I work on my computer I like to stand and put my pc on high stand, I don’t like to sit at the table…..I do have pain in so called ‘’trigger point’’, which I found, after your video, and I have been making massage for as long as two weeks and still I wasn’t healed of that ‘’scourge’’………I have a few additional questions, maybe I do smth. wrong
    1.How many times a day I have to do massage,one,two,three becouse I do two,may be it’s too much.
    2.How long is it take to be completely healed,using your method (deep massage and stick) two weeks, three or more.
    3.What can I do more to heal myself,can I do knee-bend,maybe acupuncture,may be put some ‘’cream’’ on my skin.
    4.The last one what kind of process developing inside calves in‘’trigger point’’ ? IS it inflammation,or……what is it?
    Please be so kind to find time to reply (I expect extensiveness and comprehension),it’s very important for me and a lot of others who will read this.
    P.S. I will place this request on four different sites, and I hope you’ll see and reply.
    Thank you.

  30. Isaac Walker says:

    Hey Sock Doc,

    Love your podcasts on Trailrunner nation – looking forward to the next one! Ok so I am looking for your opinion. 2 weeks ago went to my physio for some dry needling due to a ‘clicking’ right achilles (no pain just clicking upon flexing). She said both achilles they were super tight, but after session with needling and massage has loosened somewhat. Next day went on my weekend long run – medium pace 30km, achilles started to get tight half way through and had to stretch every 5km near the end to get home. Next day was very tight and sore. Another dry needle session the Monday. No running until late week – slow pace around 5km. Saturday just been had a 14km trail race and went a little too hard (which I know now was stupid) and now feeling the consequences. Could barely walk on yesterday and hobbling around today.
    I used the trigger point method last week you explained and seemed to help. Now achilles (quite high up behind ankle just below calf) after last weekend is very sore not sure how to approach treatment.
    Running in minimalist shoes for last year – 4mm drop. Quite comfortable in them but transitioning to more natural gait and I don’t think my achilles was touching the ground therefore not releasing the energy loaded in my achilles spring. I have my first 100km ultra in just under 8 weeks and want to be as prepared as possible. I would love to know what you would suggest. Thanks Dr.

    • Nothing personal to any PTs who may be reading this but it’s amazing how many comments/emails I get (as well as patients) from a person who was dry needled and either saw no results or they didn’t last more than a very short time. I don’t get it – and it’s why I see no reason for the needling.

      As I mention in the post/video, you have to assess your entire lifestyle/training if you want to successfully treat any AT problem.