General Info   Achilles Pain and Running

Achilles Pain and Running

 March 13, 2012 11



The Achilles tendon is the large tendon situated at the back of the ankle. It attached the calf muscle to the heel bone. As this tendon gets a lot of use during running exercise, Achilles injuries are suffered by many runners from time to time as the tendon is forced to work too hard. This is most likely when you change your training regime or if you do not wear the correct running footwear which correctly supports your foot and allows it to move as it should while you are running.
In such cases, scar tissue may even form over the Achilles tendon. The scar tissue, which is much less flexible than the tendon should be, may tear or rupture with further over-use. Here in this article, we will take a look at two of the most common medical problems which can occur with the Achilles tendon: tendonitis and a tendon rupture.

Achilles tendonitis

This condition is caused when the Achilles tendon, found behind the ankle, gets inflamed or irritated. This is a common injury when the tendon is over-used, such as through running, particularly in those previously unused to such exercise.

The two most common reasons for a person to suffer from Achilles tendonitis are a lack of flexibility or overpronation, where the foot bends too much in running and tends to go to the side, stressing the tendon so that if becomes inflamed.When the tendon is inflamed it swells and becomes painful. There may also be slight tears which occur in the Achilles tendon too; these tears make a rupture of the tendon more likely. The pain of Achilles tendonitis can be felt at any point over the tendon, but is most likely to be felt just above the heel. The ankle may also be stiff and redness and heat may be felt. Upon touching the area, you may feel a lump, if scar tissue has formed over the Achilles tendon.
Achilles tendonitis is most often caused by over-exercising tired and stressed muscles, perhaps through working out on muscles which have not been warmed up properly, or by increasing the distance you run too dramatically. Too much speed running or hill running can also help to create Achilles tendonitis. Pain is usually felt early on in these activities as the Achilles tendon becomes stressed.

Running shoes which have inadequate flexibility can add to the strain on the Achilles tendon too, so it cannot stretch properly and instead becomes twisted and stressed. People whose running gait makes their foot rotate too far inwards are also particularly prone to developing Achilles tendonitis.

Treatment for tendonitis, because it is usually caused by over-exertion is, first and foremost, rest. Anti-inflammatory medications which are readily available over the counter can reduce the swelling and pain and ice packs should also be applied to the affected area over the Achilles tendon at the back of the calf. Massaging your leg with arnica or an anti-inflammatory gel can also help the condition, especially if you can feel a knotted area on the tendon. Three times daily massage away from the hard area all the time, in circular motions will help. Otherwise, keep the leg elevated and rest it until the hard nodule is gone and can no longer be felt at all. After this point, gentle stretching exercises will help to reinstate flexibility in the Achilles tendon. You should refrain from running until you can once again do heel raises comfortably. Weight bearing exercises are to be avoided but swimming can be helpful to your recovery. Be patient, because with Achilles tendonitis, this can take 6-8 weeks. However, if you feel that treating yourself is not creating improvement within 2 weeks, you should seek medical advice.

To avoid a recurrence of Achilles tendonitis, you should do some training aimed at strengthening your Achilles tendon. You should also perform stretches and warming up routines thoroughly before any running activity, to protect the tendon from further damage.

Achilles Tendon Rupture

Tendon which attaches the calf muscle to the heel can actually rupture, rather than being merely strained. This is a particularly common injury in people who are not used to exercising and who therefore have little or no flexibility in their Achilles tendon. When the tendon is stretched too far, there ma be a sharp pain, experienced as a snapping or popping, when it ruptures. It can feel like you have been kicked in the back of the heel. Swelling and bruising is common, as is difficulty in pointing the toes.

People taking Fluoroquinolone antibiotics, such as for respiratory infections, urinary tract infections, and other bacterial infections are particularly susceptible to ruptures of their tendons, although it is not clearly identified why this should be so.

If the Achilles tendon ruptures, the most common treatment is surgery to attach the tendon back into its normal position once more. However, several months of having the leg in a cast may be an option to correct the Achilles tendon rupture, particularly if the sufferer leads a largely sedentary life, where casting would not be a problem.

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  • that was absolutely great advice-clear and simple but very effective. when reading it, it makes a lot of sense and its not like its rocket science!!! my achilles is in moderate pain from over training to prepare myself for events. iceing it really works the best!!! diclofenac anti-inflammatorys are subperb in correlation to ice. i can rest because i am too adicted but thank you for the great info-ice, massage and medication is doing it a treat! :)

  • While it’s true that pronation can cause a stress on the Achilles by asking the Achilles to stretch more, the primary stretch in the Achilles comes during the dorsiflexion of the foot at ground contact. This article has generally good advice, but does not address the correlations between Achilles injury and low heel-to-toe offset in shoes. The Achilles needs to be elastic so that the area from the calf to the heel can stretch. Achilles injuries are what result when that area is asked to stretch further than it comfortably can. This is why hills or fast running are often the culprit, because both activities demand a further stretch in the Achilles. It’s that lengthening of the Achilles beyond what it can handle that causes the damage.

    Now that minimalism is going mainstream, even more runners without adequately elastic Achilles tendons are wearing these shoes. While they may help your legs adapt to a more full range of motion, injury is a tangible risk, especially to a person who has gone a lifetime in standard running shoe offsets.

    Regardless of whether pronation or low heels are causing your Achilles to stretch too far, make sure to keep your calves, Achilles, and ankles as limber and spry as possible to reduce risk of injury to your Achilles.

  • After 40 years of injury free running (OK–a couple of sprained ankles from trail running), I now suffer with relentless Levaquin tendonitis of my achilles. It’s bilateral, but the right heel attachment is where I feel the most pain. It’s been 5 months since I received a steroid shot and took Levaquin for a sinus infection. I found out afterwards that there’s an FDA black box warning about that lists middle aged people who are on steroids and Levaquin at high risk for this. Neither my doctor or pharmacist told me this. Onset of pain was on day 2 of Levaquin therapy and it was profound–it began as deep pain in the soleus muscles. It hasn’t ruptured, but I had to stop running for a while and still can’t run much without pain. And forget hills! It’s very frustrating, as it came out of nowhere, when due to illness, I wasn’t even exercising. Everyone has an opinion to offer, but no one really knows how to help it. I’ve read online that it could still rupture spontaneously, and it might not ever fully recover. So, all you runners who think that antibiotics are relatively harmless, think again. Be very cautious when taking any of the quinolone antibiotics, which includes Levaquin, Cipro and some others. If anyone knows of a shoe that might be best for this problem, I’d appreciate knowing about it. I’m a very neutral runner, female, normal weight.

    • Sorry about your injury. I could not run for over 1.5 years trying to heal. One thing dramatically and imediately helped…placing my feet barefoot on the grass for 20-30 minutes after a run. Go to to learn more about how simply touching the ground after stress helps restore our electrical balance and reduce inflamation. It was amazing for me.

    • I understand what you are going through. I had the same issue taking levaquin and steroids. I was a skier, runner, tennis player etc. When my Achilles started hurting, i just pushed through, now after 3 surgeries and then a car accident and two more surgeries, i am finally able to ski again. Running is my next step. The best thing i have found is Physical Therapy on a weekly basis. I don’t think i would be able to walk with out it. If you are in the Denver, CO area. I know a great therapist. I know how awful this is and most doctors aren’t aware of it. I even hired an attorney and because I was 32 they and my achilles had only ripped not torn completely they wouldn’t take my case. I took this medicine before the black box warning and refuse to take it now. Really sucks.
      email me if you have any questions off line.
      Good luck.

  • I feel your pain, literally. I also developed chronic tendonitis from ciprofloxacin (a sister drug to Levaquin) that I was taking for a urinary tract infection. I was on crutches off and on for six months. I don’t now have pain, although a chronic stiffness in bilateral Achilles, almost like they are made of steel instead of something flexible. Doing anything on an incline for me will cause a flare up of pain that will last for weeks. Evidently it isn’t just middle-aged people that these drugs harm as much as active people. I am looking for a running shoe that will help me. I have found that gel inserts, recommended by my doctor, actually make my tendonitis worse because they cause my heel to overflex on heel strike. If anyone has suggestions I would appreciate it.

  • I have had flat feet since I was a kid. I’ve played a lot of sports over the years, but now find myself getting ready to embark upon something that will require lots and lots of running. Since I’ve started training for that I’ve notice pain in my Achilles tendon. It’s not excruciating, but certainly noticeable. The pain usually goes away after a few days, but there’s still tightness. I’m sure my overpronation is the cause of the pain. I’ll probably take a rest from running for about a week (and ride my bike for cardio instead) and follow some of the treatment directions in this article, but I’m wondering what would be the best running shoe for me…given my overpronation and Achilles tendonitis?
    I’ve been looking at the Asics Gel Evolution 6.

  • I found this page for the same reason as the other two floroquinolone antibiotic sufferers. My Achilles tendon developed a partial tear due to stepping at an odd angle while taking Cipro. It’s been almost 6 months and I literally can’t run – at all – not even to jog across an intersection at the crosswalk. I’m looking for shoes that will properly support my foot and tendon, to give me a better chance of getting back into shape, but have had no luck so far.

    • I everyone, got Cipro and had numerous side effects including the achilles and the sole fasciia. I read so much on the subject since I can’t run anymore….the solution is magnesium supplements 400mg-500mg a day. This toxin depletes magnesium in the tendon cells and the only way to regenerate them is to take mag supp non stop for a year. Tell me after 3 months ….for me a huge difference.

  • I also got chronic achilles tendonitis after taking Levaquin. Never had any issues with it before and suddenly got real bad achilles problems. That was 4 years ago and the achilles still hurts all the time and is usually very inflammed after a run. I just learned to live with it :(

  • I’m trying to find a good running shoe for my grandaughter with a torn acl(or injured).the dr said it’s ok to compete in track.I found your articles to br very informative thanks

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