Achilles tendon hurts when walking and after running: causes and how to treat?

The Achilles tendon is a large tendon that originates at the junction of the lateral and medial heads of the muscles of the back of the leg - the gastrocnemius and soleus muscles. If the impact is too strong, the tendon is overstretched and is forced to wear out. This leads to inflammation and over time can cause scar tissue to develop. If the Achilles inflammation continues to worsen, the tendon may tear or rupture.

Tendons are made up of connective tissue that attaches muscles to bones. The tendons themselves are very strong and have low extensibility. There is no clear boundary between muscles and tendons. Instead, there is a transition area - the tendon-muscular zone, where muscle fibers and tendons merge into a single whole. Only at the very end of this zone do the ligaments finally turn into white cords connecting the muscles to the bone, and it is this transition point that is the weakest link in this entire system.

Causes of Achilles pain

The causes of tendon pain are quite different:

Typically, the Achilles tendon bothers people during exercise after 30 years of age due to lack of proper warm-up, because the extensibility of the tendons decreases as the years pass.
If you have flat feet or wear shoes that are not suitable for sports, you may also experience pain in the tendon. High heels or lack thereof can cause pain.
Achilles pain can occur due to overtraining . This affects not only beginners, but also professional athletes who train too aggressively.
Damage to ligaments, bones, tendons or other connective tissues - prolonged excessive stress on the body without proper rest or movements that are too sudden for unprepared muscles.

Other causes of pain in the Achilles tendon are inflammatory diseases: tendinitis, enthesopathy or bursitis, and other diseases of the extremities.

Prevention

The best disease is the one that was prevented. We have prepared some tips for preventing Achilles injuries:

Tendinitis

The incidence of tendonitis is highest in athletes and people whose professions involve dancing or acrobatic exercise. Jumping and sharp turns have a negative impact on the Achilles tendon and cause inflammation and pain.

The Achilles tendon is made up of protein fibers that are made up of collagen. As you know, collagen has high strength, but not very good extensibility. Another protein, elastin, contracts and stretches to help provide shock absorption during movement.

Achilles tendonitis

Causes

With age, the elasticity of the ligaments is lost, so people in the older age group should never play sports without first warming up.

With excessive load, micro-tears occur in the structure of the tendon, and due to constant injuries and micro-tears of the fibers, the tendon becomes inflamed.

Symptoms

With achilles tendinitis, the patient may be bothered by the following manifestations:

the temperature lasts a long time;
hyperemia of the skin in the area of the Achilles tendon;
the tendon swells and swells , its enlargement is visually noticeable;
pain and crunching in the ankle when walking;
the calf muscle is tense and the foot moves poorly;
when there is a rupture, a hole or dip is noticeable in the area of the tendon at the back, and above the tendon, on the contrary, there is an elevation or bump.

Treatment

The most important thing for an Achilles tendon injury is immediate treatment. The faster help is provided, the less time it will take for a full recovery.

Some situations where Achilles pain requires surgery, but most can be treated without surgery (conservatively).

Conservative treatment

Self help

Achilles tendinitis requires rapid relief of inflammation. The principle of RICE (rest, ice, compression and leg elevation) is used for this purpose;
First of all, you need to apply cold to the injury site. The effect is as follows: the cold will relieve pain, and after you remove the ice, blood flow in this place will increase. Due to intense blood flow, swelling will subside and recovery will accelerate;
An elastic bandage will help immobilize the limb. This will help relieve pain and prevent further damage to the tendon. A pressure bandage will also help drain exudate and relieve swelling;
Elevating the leg will reduce the load on the tendon and help the swelling fluid “relieve.”

Medicines

Oxford University Hospitals has published data showing that 70% of athletes with Achilles tendon inflammation recover without drug treatment. However, some medications help speed up this process;
The pain can be relieved with anti-inflammatory ointments and gels. Make sure that the concentration of Diclofenac in them is about 5%;
You can use painkillers if a tendon ruptures or for the first time after an injury. However, chronic use of analgesics may slow down reparative functions, since pain indirectly stimulates recovery.

Exercises

Exercises are permissible only when relieving pain and acute signs of inflammation of tendinitis + tendinosis. Performed only as prescribed by a sports doctor;
Physiotherapeutic procedures (electrophoresis), massage, rolling the calf muscles with a roller are used;

Exercises can be divided into three groups: eccentric, isometric, ballistic.

about the benefits of the first group by accident. He had Achilles tendinosis, but surgeons did not want to operate on him because there were no signs of inflammation. Then the doctor decided to rupture the Achilles, went to the gym and, with additional load on the step, began to lower his heels to the floor. Then he felt pain, but the tendon did not rupture. The next day he repeated the training - the pain was less. As a result of constant training, the tendon recovered. This happened due to the rupture of damaged fibers and the formation of new correct ones under the force of the correct load. This effect was later scientifically confirmed.

It is important to remember that if you have a mid tendon injury, it is important to lower your heel below your toe (on the step). If you have bursitis, then from a position on your toes, simply stand on a flat foot.

Isometric exercises are the same exercises, but with the use of additional load and static fixation of the body.

Ballistic - simulate running movements and allow you to prepare for training.

Operating

When an Achilles tendon ruptures, surgery is most often used. Plaster application and self-fusion are possible for people who do not play sports. Since the endurance, elasticity, and strength of the tendon will suffer.

For tendinosis, surgery can also be performed to remove the “bad” fibers.

Steroid hormone injections: benefit or harm?

When your Achilles hurts badly after running, you want to quickly relieve this condition. Steroids come to the rescue.

Hormones quickly relieve pain and signs of inflammation (within 8-12 hours). However, they disrupt the structure of the tendon and bones and can cause osteoporosis.

We do not recommend agreeing to this procedure.

Achilles tendon injury

Active people are always at risk of tearing, spraining, tearing or bruising ligaments. When an injury occurs, pathological processes occur in the ligamentous system of the ankle joint and tendons. When a joint is dislocated or a severe sprain of a ligament, micro-tears of the Achilles tendon tissue can occur.

With gradual recovery, these small tears are overgrown with connective tissue, which scars and subsequently disrupts the physiological functioning of the Achilles tendon. In this case, there is no normal fixation of the bone heads in the articular capsule.

Causes of injury

The main causes of Achilles injuries:

If there is a strong blow to the straight leg, the Achilles tendon can be damaged . This type of injury usually occurs in athletes involved in volleyball or running. In everyday life, according to statistics, there is much less chance of getting such an injury; the victims are mainly children.
Injuries from sharp objects can also tear or strain the posterior Achilles tendon.
One of the provoking factors may be the degradation of the special structural protein collagen, which is part of the tendon tissue.
The use of drugs such as corticosteroids increases the likelihood of destructive processes, as a result of which the Achilles tendon loses strength.

Symptoms

Symptoms of an Achilles tendon injury depend on the location and force of the impact:

In the case of a severe complete rupture of the tendon, the pain may be mild, but the person will not be able to pull his toes; the pain will prevent him from doing so.
After some time, swelling occurs in the area of injury and visible subcutaneous hemorrhages. The back of your leg may swell.
Some may experience severe pain . At the same time, the patient cannot move his leg either.

What does the diagnosis of pain depend on?

Before you understand how to treat your Achilles tendon, it is important to get the correct diagnosis.

For this, of course, it is important to seek medical help. An experienced doctor will examine the site of pain, palpate it and prescribe an x-ray, ultrasound or MRI. Why is this necessary? — To determine the exact location + extent of damage, he will prescribe the correct treatment.

Localization

Achilles pain is an abstract complaint. The area of damage can be localized in three typical locations:

The upper part is where the gastrocnemius and soleus muscles transition into the tendon. This area is well supplied with blood and innervated - despite severe pain, it recovers quickly;
The middle part is the Achilles tendon itself in the place of the so-called “string”. It can be felt by pinching movements along the back of the ankle joint. The “string” has practically no blood supply - 8 times worse than the upper part. Most often, with tendonitis, a small painful bump forms here;
The lower part is where the tendon attaches to the heel tubercle. This is where the joint capsule is located and bursitis occurs. The distinctive symptom is a painful, red, hot tubercle in the lower part of the tendon + absence of pain when palpating the Achilles itself (string).

Stage of damage

We have considered typical localization, but there are other differentially significant signs. In particular, the stage of damage. Treatment tactics directly depend on this; they will differ radically for different pathologies.

First, inflammation occurs, then fiber destructuring occurs, “elastic” collagen is replaced by dense collagen, then rupture occurs. We'll talk about each stage in more detail below.

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Achilles tendon bursitis

Achilles bursitis is also an inflammatory disease. Bursas are small cavities around joints filled with fluid. This fluid helps reduce friction between the joint cavities.

Causes

When an infection gets inside or the surrounding tissue is damaged, an inflammatory process called bursitis can begin in the cavities of the bursa. Achilles bursitis is an inflammation localized directly in the area of the Achilles tendon.

Achilles bursitis

Symptoms

The combination of signs of calcaneal tendon bursitis allows us to determine the disease:

Tissue swelling occurs above the heel at the beginning of the tendon.
The epicenter of pain is in the ankle joint.
Walking in shoes with Achilles bursitis is very painful for the patient.

Location of the Achilles bursa

Achilles tendon enthesopathy

Enthesopathy is a tendon disease in which inflammation occurs at the sites where tendons and ligaments attach to bones. Most often they are located near the joints.

Causes

The reason for the development of this disease is neglected, untreated injuries. Therefore, Achilles enthesopathy is usually present in football and basketball players, who are often injured during play.

People in active professions who spend a lot of time standing, or those involved in heavy physical labor are also more susceptible to Achilles enthesopathy.

Symptoms

Tendon inflammation is usually characterized by symptoms in which you should immediately consult a doctor:

Fever.
Intense pain in the area of the inflamed Achilles, which typically increases with muscle tension and decreases with relaxation.
Limitation of joint mobility.
In the Achilles area, the tissues may swell, swell, the skin turns red, and the process is accompanied by pain.

First aid at home for Achilles injury

When pain syndrome begins to appear regularly and interferes with normal activity, it is necessary to consult a doctor for diagnosis and prescribing adequate treatment.

First aid at home is important to provide as early as possible:

Immediately after pain occurs, you need to remove the load and ensure rest of the limb.
You should not exercise or lift weights for several days until the pain goes away.
Apply cold to the damaged area : in the form of a compress several times a day for 10-15 minutes.
You need to select shoes carefully , taking into account the specifics of sports activities.
In case of pain in the Achilles tendon after running or other sports, it is recommended to fix the ankle with an elastic bandage or tape.
Women should stop wearing high heels to relieve stress and pain on the Achilles.

What is Achillodynia and how does it develop?

Achillodynia
is a pain syndrome resulting from inflammation of the Achilles tendon and its surrounding membranes.
The disease usually develops after excessive
exercise. Unprepared people often suffer from Achillodynia after overly intense training. This applies not only to running disciplines, but also to other sports.

Overweight people

also often have problems with the Achilles tendon.
Rheumatism
and
foot deformities
increase the risk of developing Achillodynia.

Causes

Signs and symptoms

Treatment

Products

Anatomy

Being the most powerful tendon in the human body, the Achilles tendon (lat. tendon Achillis

) transfers the force of the lower leg muscles to the foot. This ensures the foot lifts off the surface when walking and running. When you run, the Achilles tendon experiences a force equal to eight times your own body weight.1

Anatomy of the Achilles tendon

Risk factors and causes

The main cause of Achillodynia is overstretching the Achilles tendon. At the same time, activities that can cause pain are very diverse.

Sports activities

Intense running and jumping loads
Unusual loads, for example too much load after starting to play sports
Systematic overloads

External factors

Inappropriate shoes
Smoking
Taking certain antibiotics

Anatomical factors

Aging
Foot deformities
Shortening of tendons or muscles
Increased uric acid levels
Rheumatic diseases
Excess body weight

Signs and symptoms

The clinical picture varies from discomfort to inflammation of the Achilles tendon. In some cases, inflammation can cause actual rupture. Characteristic symptoms of inflammation: pain, local increase in temperature, swelling and dysfunction

At first, symptoms appear only at the beginning of physical activity and disappear after a short period of activity. In the future, pain and swelling persist for a long time.

Treatment of Achillodynia

Treatment of Achillodynia is almost always conservative.

. The earlier treatment begins, the more successful it is. The most effective is complex treatment, which consists of the points listed below.

Therapeutic exercise:
special eccentric exercises2 help rebuild tendon tissue. It is recommended to do the exercises for a few minutes twice a day. Depending on the clinical picture and phase of the disease, the doctor may prescribe physiotherapy (ultrasound), electrotherapy (TENS), transverse kneading (special massage), shock wave therapy or acupuncture.
Bandages:
Special medical devices (eg Achimed by medi) reduce tension and stress on the Achilles tendon. The compression fabric and the built-in silicone insert together provide a gentle massage effect on the Achilles tendon and improve blood circulation in the area of inflammation, which reduces pain. Additionally, in the acute phase, patients can reduce their Achilles tendon pain by using heel pads that are used simultaneously in both shoes.
Insoles:
Orthotics (such as igli Heel Spur Light) reduce stress on the Achilles tendon.
Cold
: cooling compresses relieve pain and swelling (compress temperature is about 7°C).
Heat
: A heating pad, hot water bottle or massage with a towel soaked in warm water will improve blood circulation in the area of inflammation.
Medications
: If necessary and as recommended by the treating physician, patients take anti-inflammatory drugs such as ibuprofen or diclofenac for one to two weeks.
Ointments
: Anti-inflammatory creams or ointments can be rubbed onto the affected area several times a day.

The treatment plan is drawn up by the attending physician individually for each patient. This takes into account the special needs of the patient and the clinical picture at the current time.

Physiotherapy

Eccentric exercises2 are an effective method for treating Achillodynia. This has been proven by various studies3. Among similar exercises are calf raises

considered basic.

The exercise should be performed twice a day for at least 12 weeks.

The exercise can be performed on a step (such as a staircase) and does not require fitness equipment.

It is important to know:

During the first two weeks of exercise, pain in the lower leg muscles may occur. Be patient and continue the exercise faithfully. If the pain becomes too severe, reduce the number of sets. If this does not relieve pain, and if you experience pain during daily activities, stop exercising and contact your healthcare provider.

Diagnostics

Diagnosing an injury or complicated inflammatory process is not difficult if the doctor is experienced enough. First, you need to contact a traumatologist or therapist at your place of residence. Due to the abundance of species, diseases such as, for example, achilles tendinitis are difficult to differentiate from other pathologies.

In addition to palpation of the limb, collecting anamnesis and telling the patient about the symptoms, there are other ways to make a diagnosis in medical practice:

Checking the ability to bend the leg at the knee . The person lies on his stomach and bends his knees. In this case, the injured limb will hang lower than the healthy one.
Checking the ability to extend the leg . The doctor squeezes the patient's relaxed shin. Free stretching of the leg indicates no damage to the tendon.
A sphygmomanometer device is used . The doctor uses a sphygmomanometer to check the pressure level before and after ankle movements.
Checking with a medical needle. A regular needle is inserted between the calf and the Achilles and watched as the needle changes inclination as the patient moves his leg.

Treatment of Achilles diseases

In acute cases, conventional methods are indicated. Reducing physical activity, using anti-inflammatory drugs for pain, special exercises to stretch the tendon, massage. To limit the range of motion, it is possible to use soft orthoses and elastic bandages.

Healing chronic inflammation or old injury requires more effort and time. It is recommended to immobilize the ankle joint with rigidly fixing orthoses. Kinesio taping is used to unload the tendon using special adhesive tapes, and physiotherapy.

Surgical treatment is used as a last resort when conservative treatment does not bring results within a certain time.

Medicines

To relieve inflammation of the heel tendon and pain syndrome, medications are prescribed by a doctor based on the characteristics of each case:

NSAID drugs work effectively in combination with other drugs. Ketorolac, Nimesil, Baclofen, Meloxicam are usually used.
High fever must be reduced with antipyretic medications.
A compress of Dimexide with Novocaine , Hydrocortisone or Dexamethasone is recommended to be used day or night for several days to reduce swelling.
At home, various ointments and gels based on combined products will help you get rid of pain - you can smear Solcoseryl, Bytrumgel, Dolobene gel, Nurofen gel, Butadione.

Meloxicam

Nimesil

Baclofen

Dimexide

Bystrum

Dolobene gel 50 grams

Fixation

Methods for fixing the ankle should be selected by an orthopedic surgeon:

A good way to protect yourself is to wrap your leg tightly with an elastic bandage before training. Also, if you feel pain, you can also use a bandage that will securely fix your legs and will not allow you to strain this part.
It is possible to apply kinesio tape during training.
You can also wear an orthosis or bandage at night . It is used to fix the foot bone at a right angle. In advanced forms of the disease, it is not recommended to remove it during the day.
Sometimes, when standard treatment is ineffective and the athlete is highly active, the traumatologist is forced to plaster the ankle and leg to the knee in order to avoid the consequences and complications of the injury. In this case, wearing the plaster usually extends for a period of 1.5 to 4 months.

Foot support orthosis Night orthosis

Articulated orthosis for tendon injury

Exercises

When performing exercises, you need to monitor pain sensations; if pain occurs, exercise or stretching should not be performed.

A few simple exercises to do before each workout that will help avoid many problems:

Exercises with dumbbells to stretch muscles. It is effective to lunge with your left or right leg, while the other leg remains bent behind you. The body needs to be lowered quite slowly and low.
You can also do jumps, that is, lunges at higher speeds . The exercise is done 10-15 times daily.
Tiptoe walking exercise. You can perform it either with dumbbells in outstretched arms or without them. You need to walk like this for 3-5 minutes, stretching your whole body and straightening your shoulders. Then you can take a break and do another approach.

Recovery Exercises

Performing classic stretches against a wall, which athletes do before running, will also help prepare the muscles and ligaments for the load.

Physiotherapy

Physiotherapy has a good effect in treatment. The therapy allows you to stretch the muscle, which helps relieve tension on the Achilles. Therapeutic ankle massage, ultrasound and weak current pulses are used.

Operation

In case of a complete rupture of the Achilles or injury to the triceps muscle of the leg, an operation to suturing parts of the tendon is necessary to eliminate the consequences. Moreover, the sooner surgery is performed, the faster tissue restoration can be expected.

Modern surgical technologies make it possible to treat the Achilles tendon with minimal trauma, therefore, the recovery time after surgery is significantly reduced.

Tendon suturing surgery

How to choose the right running shoes?

To prevent Achilles tendinitis from recurring, strengthen and stretch your calf muscles. An excellent exercise to strengthen the Achilles using rubber bands . When we work the ankle back and forth and left and right, we have resistance in the form of rubber.

The second exercise that will help to simultaneously strengthen and stretch the muscles we need and work on the tendon is calf raise . We stand on a small step with the front of our feet, so that the heels hang down. And we begin slow ascents and descents. You can stay in one position for 10-20 seconds.

Don't forget that properly selected orthopedic shoes with a slight drop between the toe and heel are the ideal solution. During tendonitis, it is best to avoid hill training to avoid over-exerting yourself. And be sure to include rest in your training schedule.

Traditional treatment

Folk remedies will help reduce the severity of sprain symptoms, relieve swelling and pain. For complex injuries, a more drastic solution must be applied.

Here are some recipes:

Elderberry decoction is made like this . To treat tendons, boil green elderberry in three liters of water and add 1 tbsp. regular soda. The decoction can be used in the form of foot baths or lotions.
Plantain seed: 2 tbsp. l. Pour 1 cup of boiling water over plantain seeds. Boil. Cool, mix well, pass through a sieve and drink 2 tbsp. l. 3 times a day.
Heat treatment. Heat helps relieve swelling. Pour slightly heated sand into a material bag and apply to the injured leg, leaving for 10-15 minutes. You can use salt and wheat.
Onion compress. Grind a couple of onions to a porridge state and mix with 1 tablespoon of sea salt. The mixture of onion and salt is placed on a cloth and applied to the back of the leg. The compress should be kept for several hours for 2-3 days.

Shilajit-based compresses will also help relieve symptoms of inflammation, pain and swelling; you can use a Shilajit solution from tablets sold in pharmacies for treatment.

How to start running after an Achilles tendon injury

How long will Achilles tendinitis take you out of your workout routine? When can you start training, and how to do it correctly?

The duration is determined by the cause of the pathology.
With the right approach, inflammation goes away within a few weeks. If the injury is serious, it will take about 2 months.
Tendinosis is more difficult to treat. It will take 2-3 months of active recovery or surgery.
Surgery after ligament rupture requires a long rehabilitation period - up to six months.

The main thing is to return to training gradually, after pain relief.

Perform eccentric loading on the joint using a step. Slowly lower your heel below the level of your toe, and use your other leg to lift - do 3 sets of 15 minutes, 2 times a day. When discomfort disappears, use weights;
Squat on your heels using the step. Socks should hang down. Do 3 sets 10-12 times;
Massage your calves on the roller back and forth without touching the tendon itself. The muscle needs to stretch to reduce pain and strengthen the joint;
Stretch your calf muscles against the wall with emphasis on your arms daily;
Jump smoothly in place until you feel slight discomfort.
Forget about running uphill, interval training until you are fully recovered.

Recovery and rehabilitation

To quickly restore Achilles tissue in case of chronic or acute illness or injury, it is necessary to strictly follow all the instructions of the attending physician.

Clinical recommendations for the rehabilitation period:

reduce the load on the affected leg as much as possible;
move for some time with the help of a cane or crutches (if necessary);
if intense pain occurs or swelling increases, you should immediately inform your doctor about the appearance of other manifestations of the disease;
maintain bed rest immediately after surgery and during severe pain;
reducing pressure on the tendon by purchasing good special shoes;
fix the ankle joint and foot with an orthosis or wear an elastic bandage for a period of one to three months;
Be sure to use physical therapy in the late stages of recovery.