How one tendon can throw you off your stride

The Achilles tendon is a long band of tissue that connects calf muscles at the back of the lower leg to your heel bone. This tendon is used when walking, running, jumping or pushing up on your toes.

But if it's injured, the pain, typically located in the back of your calf, and lack of function can throw you off your stride for months.

Recognizing when you're at risk for Achilles tendinitis and knowing how to prevent it can keep you walking, running and exercising without pain.

Who's at risk

Achilles tendinitis most commonly occurs in people who suddenly begin increasing the intensity or duration of exercise or haven't been appropriately trained for their sport.

Overuse activities, such as walking the dog, hiking, basketball and golf, also can lead to injury and make the problem worse. But you're also susceptible due to:

• Your sex
  Achilles tendinitis is most common in men.
• Age
  You're at a higher risk as you get older.
• Flat feet
  A naturally flat arch in your foot can put more strain on the Achilles tendon.
• Obesity
  Carrying extra pounds also increases tendon strain.
• Poor footwear
  Running in worn-out shoes or wearing footwear inappropriate for your sport can injure the tendon.
• Weather and terrain
  Tendon pain occurs more frequently in cold weather than when it's warm out. Running on hills also can put more stress on your Achilles tendon.
• Medical conditions and medications
  People with psoriasis, high blood pressure or who take certain types of antibiotics, called fluoroquinolones, are at higher risk of developing Achilles tendinitis.

Preventing tendon injury

Although you may be at risk, these simple strategies can help prevent injury to your Achilles tendon:

• Increase your activity level gradually.
  If you're beginning an exercise regimen, start slowly and gradually increase the duration and intensity of the training.
• Take it easy.
  Avoid activities that place excessive stress on your tendons, such as hill running. If you participate in a strenuous activity, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.
• Choose your shoes carefully.
  The shoes you wear while exercising should provide adequate heel cushioning and firm arch support to help reduce the tension in the Achilles tendon. Replace your worn-out shoes. If your shoes are in good condition but don't support your arch, try adding supports in both shoes.
• Stretch daily.
  Take the time to stretch your calf muscles and Achilles tendon in the morning, before exercise and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendinitis.
• Strengthen your calf muscles.
  Strong calf muscles enable the calf and Achilles tendon to handle activity and exercise stress better.
• Cross-train.
  Alternate high-impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

Treating Achilles tendon injuries

Most Achilles tendon injuries can be treated at home using the RICE guidelines:

• Rest
  You may need to avoid exercise for several days or switch to an activity that doesn't strain the Achilles tendon, such as swimming. In severe cases, you may need to wear a walking boot and use crutches.
• Ice
  To decrease pain or swelling, apply an ice pack to the tendon for about 15 minutes after exercising or when you experience pain.
• Compression
  Wraps or compressive elastic bandages can help reduce swelling and reduce movement of the tendon.
• Elevation
  Raise the affected foot above the level of your heart to reduce swelling. Sleep with your affected foot elevated at night.

Over-the-counter medications, such as ibuprofen or naproxen, can help reduce inflammation and relieve pain.

If the pain continues or worsens, you may want to talk with your primary care provider or a foot and ankle specialist who can address both orthopedic and podiatry issues. You may need imaging tests, including X-ray, ultrasound or MRI, to better diagnose the injury to the tendon.

Your health care team may recommend that you see a physical therapist. Typical physical therapy includes:

• Exercises
  Therapists often prescribe specific stretching and strengthening exercises to promote the healing and strengthening of the Achilles tendon and its supporting structures. Eccentric, or negative, strengthening involves slowly raising and lowering a weight. It's especially helpful for persistent Achilles problems.
• Orthotic devices
  A shoe insert or wedge that slightly elevates your heel can relieve strain on the tendon and provide a cushion that lessens the force exerted on your Achilles tendon.

If several months of conservative treatments don't work or if the tendon has torn, your health care team may suggest surgery to repair your Achilles tendon. Healing can take months, so it's best to be aware of your risks and practice preventive strategies to keep you active and pain-free.

Next Steps:

• Learn how to choose the best shoes for exercising.
• Consider seeing an orthopedic or sports medicine specialist to aid your recovery.
• Discover the right way to start or restart an exercise program.
• Find a physical therapist near you.
• Want to shave off some pounds? Try these tips to get your weight loss back on track.

Heather Schaefbauer, D.P.M., is a podiatrist in La Crosse, Wisconsin.