Achilles is one of the most famous names in Greek mythology—and the tendon named after him is one of the most important components in the group of muscles and bones that propels the runner. This tendon’s job is to drive the foot down and forward.
There’s no record of whether Achilles was a runner, but he was one of the most famous Greeks who fought in the Trojan War 4000 years ago and he’s the hero of Homer’s Iliad.
But the reason why Achilles has been immortalized is because of his mother Thetis. Right after Achilles was born, Thetis decided to make him physically immortal. Good decision.
To immortalize him, Thetis held the infant by his heel and dipped him in the River Styx. Evidently, everything that touched the Styx became invulnerable. This would have worked out great, except that Achilles’ heel remained dry… and sadly, unprotected.
It would prove to be his one weakness. Though he fought bravely in the Trojan War, he was wounded in that one vulnerable spot—the heel—and died from his wounds.
Many centuries later, runners still feel the soreness and vulnerability of Achilles. Fortunately, it isn’t fatal, but runners commonly have heel soreness that can manifests itself with Achilles tendonitis. That soreness usually isn’t a big deal, but if it is not properly treated, it can become so painful that even walking is difficult. In extreme cases, the Achilles can tear or rupture which necessitates surgery and a lengthy recovery and rehab period. Again, not fatal though.
The Achilles tendon is a fibrous tissue on the back of the foot which connects the heel to the muscles of the lower leg: the soleus and calf muscles. When the calf muscles are contracted, they pull the Achilles which pushes the foot downward. This complex contraction is key to any human’s movement. It allows for standing on the toes, running, walking and jumping.
With every step, each Achilles tendon is subjected to a person’s entire body weight. Depending on speed, stride and terrain and additional weight being carried or pushed, each Achilles may be subjected to anywhere from 3 to 12 times a person’s body weight.
If the Achilles is healthy, it accepts the huge amounts of weight and forced placed upon it without any trouble. But if certain situations occur, the Achilles can be repeatedly strained—and injured.
The most reliable estimates gauge the number of Achilles injuries at about 250,000 per year and certainly a high percentage of those injuries are to runners.
Injuries to a runner’s Achilles can be caused by a number of factors including muscle imbalances, uneven leg lengths, switching back and forth between high heels and running shoes, too much use of racing flats or spikes, abrupt increases in training intensity, speedwork or hills.
For runners, the typical Achilles injury is Achilles tendonitis. Symptoms come on gradually and continue to worsen unless treated. Symptomatically, there is (1) pain or soreness in the tendon which gets worse as you run. (2) There is stiffness or soreness in the tendon which lessens with running. When you stop, the soreness returns. (3) Persistent pain that is often the worst in the morning. The tendon is very stiff and doesn’t warm up with use.
To confirm that these symptoms are Achilles tendonitis, lightly pinch the tendon and it should elicit further soreness or pain. If not, it may just be post-run soreness.
Achilles tendon tears or ruptures come on suddenly, often with a popping sound. Complete tears or ruptures are more common in ballistic sports or jumping or sprinting, but partial tears can disable long-distance runners too. The only way to tell if the tendon is completely torn or partially torn is to see a physician. Unfortunately, the treatment usually involves surgery and lengthy immobilization.
Achilles tendonitis among runners is usually associated with four factors:
- Overtraining. The runner is simply running too many miles, too much speedwork or doing too many hills (usually downhills). Or that runner has increased the training load too quickly and the Achilles was not strong enough to adapt to the intensity.
- Worn-out shoes. Most distance runners are heel strikers which is fine. But running on your heels in worn-out shoes is a recipe for Achilles problems. A heel striker will wear out a running shoe quickly in one area: the outside portion of the heel of the shoe. This is where a heel striker lands and the cushioning wears out quicker here than the rest of the shoe. Once this area of the shoe is worn out, it will force the Achilles tendon to overstretch upon heel strike. Since running is such a repetitive sport, running on a worn-out shoe is a common cause of Achilles tendonitis.
- Improper shoes. Even if you are wearing shoes with plenty of cushioning, if you are wearing the wrong type of shoe the Achilles tendon will swell and become inflamed. Obviously, wearing running shoes (and not cross-trainers, basketball shoes or tennis shoes) is critical. But wearing the right type of shoe is also important. Heel strikers generally need a supportive, stable shoe (either motion control or stability shoes) which supports the heel throughout the gait cycle and doesn’t allow it to move excessively in the rearfoot of the shoe.
- Minimal, barefoot, low or zero drop shoes. With these types of shoes, the heel is much lower to the ground than conventional shoes. For some runners, this is perfectly fine. But many either have a hard time adapting to the lowered heels or try to adapt too quickly and differ from Achilles soreness. If you switch to shoes with lower heels, give yourself plenty of time to adapt to the different stresses.
Additionally, if you have been wearing spikes for track practice (especially high schoolers), consider switching to more conventional training shoes. Similarly, wearing racing flats too much for training (again, lower heels) can also cause Achilles problems so change to trainers.
Women who wear high heels much of the time for business or fashion reasons are also vulnerable to Achilles injuries. If that’s you, try and wear more appropriate dress shoes that place less strain on the tendon.
Once the Achilles is injured, you must be careful not to worsen the injury. Either stop running or reduce your training volume, speed and intensity. Stay off hills. Get new shoes and try to run on smooth, even surfaces.
If you can still run, use ice to massage the Achilles after every run to reduce the inflammation. Anti-inflammatories will also help. Often, a temporary heel left will reduce the length the Achilles needs to stretch and relieve some of the symptoms.
If you can’t run or the injury has become chronic, seek medical attention. Often, the Achilles will respond to such traditional physical therapies as ultrasound, electrical stimulation, cold laser and massage.
Part of any treatment should also include a stretching and strengthening program. Consult with your physician or therapist for the most effective stretches and strengthening techniques.