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Injury Archives: Inflamed Achilles

With the normal stress of running, small micro-tears occur in the tissue of the Achilles tendon. Normally they heal quickly. However, if there is too much stress and too little rest, they won't heal, will collect in an area and produce inflammation.

Diagnosis. Inflammation is usually at the narrowest part of the tendon, at the paratenon sheath. The fluid between the tendon and the sheath expands. There is often a cracking noise when moving the tendon, and it may be sore. (This is rare.)

Treatment: Ice massage for 10 minutes at least twice a day. Use a heel lift ­ felt, cork, etc. (a Spenco is too soft) ­ in both running and street shoes ­ to reduce tension on the tendon. Take aspirin (with meals or with milk) if okay with your stomach and your doctor. Be regular with it for a week or so to tell if it's effective. It reduces swelling. Consult with doctor about length of layoff.

Achilles Tear: When the tendon is already weakened, it can be partially torn by the additional stress of speedwork, hill running or simply stepping in a hole. A complete tear is a more serious and painful injury. This often requires surgery, but fortunately tendon tears occur in only about two percent of Achilles injuries.

Diagnosis: If you can't rise up on your toes while standing, you may have a tear. There is a lump in the lower calf area and a gap where the tendon is torn. You can feel this through the skin. If you suspect a tear, try to find a specialist who has a good deal of experience with Achilles problems.

Treatment. Ice massage and use heel lift as for inflamed Achilles (above). Don't run for at least 4-6 weeks (or length of time prescribed by doctor) to let swelling subside and healing process begin. If you stop at an early stage, your "vacation" may be only a few weeks, but if you push the tendon too far in this state you may be out for months. Consult with your doctor. When starting back, run every other day for another 4-6 weeks ­ or until things feel better and normal functioning has returned.

NOTE: Beware of injections of cortisone or other steroids, for they may weaken and/or dissolve the tendon. Get several opinions before getting such a shot; it could set you back months, years or permanently.

From Galloway's Book on Running by Jeff Galloway (Shelter Publications, 1984) pp. 216-218

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