The 411 on Achilles Pain
Have you noticed that since you’ve been working from home, you are experiencing more pain in the back of the heel? Most likely, this is because of an unhappy Achilles tendon. We are now wearing shoes less often because we are in our homes more and with each step we are pulling on what is likely a pretty tight tendon. Shoes essentially shorten the tendon, removing some of the pull on it when walking, making barefoot walking at home more painful.
All About the Achilles Tendon
The Achilles tendon gets my respect all day long! It is the quiet puppeteer of the entire foot and ankle, yet is very delicate. By the very nature of how it was designed, it is prone to injury. Most commonly, the tendon inflames or tears near the bottommost part of the heel where the blood supply is shabby.
Injuries to the Achilles are Difficult to Heal
Because the tendon doesn’t heal itself very well, Achilles’ problems can linger and become chronic, or the tendon can just tear without warning. It is a problem no one wants to have. So, when I first felt pain along the back of my heels a little over a year ago, I panicked. First thing I noticed was a burning at the back of the heel if I laid down too long with my heels against the bed. This turned into discomfort and tightness during my first few steps in the morning, then during my workouts! Thankfully, there is a solution for most that doesn’t involve surgery.
How Do I Treat My Achilles Pain?
To understand how we treat it, you need to understand what causes Achilles tendonitis (AT). AT is caused by a combination of tightness of the calf muscle and tendon AND overuse. Occasionally, other factors, such as external pressure on the heel (from an ill-fitting pump or shoe), can start the problem. As we walk and our foot points upward, the muscle and tendon stretch. So, if the muscle and tendon are tight, that motion can cause pain. Eventually, the tightness combined with too much activity can lead to inflammation and very tiny tears in the tendon.
AT usually presents in two different ways.
1. Achilles Tendonitis from overuse
2. Achilles Tendonitis in a non-athlete
Regardless of which category you fall into, the treatment is essentially the same and focuses on stretching and strengthening.
Treatment Advice
Avoid Activities that Cause Pain
1. Activity modification. If you are working out daily or just started a new program and are noticing pain, you should take a break and switch to another form of exercise until the swelling or pain resolves. This is a hard to pill to swallow but you must modify and listen to your body.
Avoid Walking Around Bare Foot
2. Elevate your heels. You may need to add a small heel wedge in your shoes (can be found online), wear a heeled shoe, and minimize walking around barefoot or in super flat shoes. In fact, I NEVER walk around the house without either my indoor Birkenstocks or another mule-type shoe with arch support and a slightly raised heel. As your flexibility improves, you may eventually ditch the indoor support, but be careful.
Use Anti-Inflammatory Treatments
3. If cleared by your doctor and you are having significant swelling and pain, try an over-the-counter anti-inflammatory medicine or a natural remedy for inflammation for a few days.
Stretch!
4. Once the acute pain has settled, you must STRETCH, STRETCH, STRETCH - like one of those folks (present company included) that you see stretching when waiting to cross the street! Stretching first thing in the morning and two or three additional times throughout the day for just a few minutes is key. This should take less than 4 to 5 minutes total! Check out my IG video below on how to stretch (@drevamd)! Ideally, once the significant pain has resolved, you can begin performing eccentric strengthening exercises. This means that you are strengthening the tendon while it is being stretched. WHAT!!! Think of a slow and controlled heel drop, then later, progress to adding a 1 or 2 pound weight in each hand after a few weeks. Remember - stretch until there is a slight pull, but do not extend to pain.
See Your Doctor
5. If stretching aggravates your pain, or your tendon is swollen, hot, or warm, then it is time to see your doctor! Sometimes, a walking boot or special sleeping braces may be necessary.
FAQ: “Dr. Eva, I sit at a desk all day and cannot find the time to stretch. How do I deal with this?”
Answer: Try “The Seated Achilles Stretch with Bosuball” in my IG video, so you can stretch as you work!
Link: https://www.instagram.com/p/CO6H660n1Hw/
**A special note to all my men over 35! You are in the group at risk for an Achilles rupture while having no symptoms at all. Sorry, but while you’re trying to get your Michael Jordan on while playing hoops, you really are rolling the dice. This was the most common indication for an Achilles surgery in my practice–a middle ager playing basketball. Take my advice and cycle or swim.
Finally, if you are having a problem with your Achilles, please take it seriously. The remedies above do not take the place of a full evaluation by your physician. When in doubt, please see your doctor or an Orthopedic Surgeon.
That’s all for now guys, hope this helps.
Take care of you,
XOXOXOXOX
Dr. Eva