What to do about them
Once you have had an achilles injury, it is very difficult to clear it up completely, as the achilles has a poor blood supply and takes longer to recover. It also requires extra manual, or machine, help to speed up the healing process. Then there is the actual time it takes to heal. Normal soft tissue injuries like pulled muscles can be cleared up in weeks, while an achilles tear, because it is a tendon, can take months.
There is a positive side to this though, as the achilles is incredibly strong and, if taken care of with correct shoes and stretching techniques, can last through a lifetime of running. Problems start when there is some twisting of the achilles due to poor biomechanics (a poor footplant being the prime example) of the lower legs. This twisting puts excessive stress on the achilles area and thus weakens it. It can lead to swelling and a feeling of creaking in the achilles itself.
Creakiness is the most common achilles injury and can be cured most of the time, if it is caught early enough. This is called achilles tendonitis and is caused by inflammation of the achilles tendon itself or its covering sheath. The tendon is one of the biggest and strongest in the body and is essential for good gait and posture. The main causes of achilles tendonitis are overuse and injury.
Signs and symptoms
Overuse injury: pain may be felt before and after exercise, but this generally eases during movement. If the aggravating factor continues, the pain will become more constant, often throbbing. There may be some swelling or bruising around the tendon and this may lead to stiffness, especially after a period of rest when the tendon is in a shortened position.
Overuse injuries may be caused by:
- Too much, or a change in, training methods.
- Inappropriate footwear.
- Tight muscles.
- High impact or repetitive activities.
- Underlying foot problems.
- Unaccustomed activity, e.g. the first run after time off.
Traumatic injury: pain usually has a sudden onset, just above the heel. This may change to a constant dull pain, usually felt when overstretching the damaged soft tissue. There may be some swelling and heat around the tendon after the injury and movement may be limited, with an inability to walk normally, run, stand on tiptoe or pull the foot up.
If you suspect serious injury and you are unable to walk or put your foot on the ground, or if the pain gets worse, then seek medical advice.
Treatment
Don’t forget PRICE:
P: protection
You may need to protect the injured tendon during the first day or two. This may be protective covering or a small heel raise in the shoe to rest the tendon in a shortened position and prevent overstretch.
R: rest
Rest your injured leg and give things a chance to settle down.
I: ice
Use a covered ice pack on the injured area, wring out a thin towel in cold water and cover the ice pack. Use for ten to fifteen minutes. Remember to protect your skin, as ice can burn.
C: compression
You may need to apply pressure to the ankle with a bandage to reduce any swelling.
E: elevation
If there is any swelling, keep the foot up and this will help the fluid to drain away. Compression may not be necessary if the injured leg is elevated.
From the second or third day, start to gently exercise the injured tendon. Start to walk as much as discomfort allows, with a normal gait. You may feel a stretch, but at no time must this be painful.
Over the next few days as symptoms subside, start gentle stretches to the achilles tendon. Increase the speed of walking and gradually introduce jogging. Build up to running as improvement allows.
Finally check your running trainers and make sure they are suitable for your running gait. There are a lot of manufacturers out there, producing trainers for all types of runner. Some are for forefoot strikers; while others are for heal strikers. The type of shoe can have a big impact on your susceptibility to injuries, as a poorly fitted pair or the wrong type can make you run differently, and produce biomechanical problems leading to injuries. This is why it is so important to get your shoes from a knowledgeable running store who can advise you on these possible problems.
If you have had achilles soreness, then a simple way to alleviate the pressure that some trainers can put on the achilles area is to modify the heal tab. Sometimes this can be either too high; curve inwards too much, be too hard, or a combination of all three. If this is the case then the achilles area is being rubbed every step of a run, leading to inflammation, aggravation and long term soreness of the area. It may seem an odd thing to do, but by cutting the heal tab you are releasing some of the pressure that can be exerted on the achilles.
Most people won’t need to do this; in 90% of runners their shoes will be fine. However, if you are in the other 10% of achilles sufferers, prepare to attack your shoes! You will need to make some small cuts in the heal tab of the shoes (see diagram left). The important thing to remember here is not to make the cuts too long, as this can cause more problems than it solves. All you are trying to do is reduce the pressure exerted from the heal tab onto your achilles.
Start with a cut in the middle of the tab (you will need a sharp knife or scissors) and go down no more than 1cm. Less is better to start with, as you can always cut them down a little more afterwards if you are not happy with them. You should be able to feel how stiff the heal tab is with your fingers and by making multiple cuts you reduce this stiffness and make the area softer.
Around six to seven small cuts will be ideal, but if you are worried just start with three and see how you get on. You will notice a difference immediately when you run, as there should be no more rubbing and your achilles should feel free from restriction. If you also visit a biomechanist to get your feet assessed for possible orthotic inserts, then you are doing everything possible to reduce the likelihood of injury.
The good news is that, by being cautious and listening to your body, you can pre-empt any problems and nip them in the bud before they cause any real long term damage.