Pilates For Achilles Tendinitis

June 3rd is National Running Day and many running organizations from across join forces in an effort to promote running as an easy, healthy, affordable form of exercise. Unfortunately, runners are susceptible to foot problems, including heel pain, tendinitis, ankle sprains, stress fractures and blisters. Proper shoe fit and training are two of the easiest ways to prevent foot and ankle injuries while running. This article review the top 5 foot problems in runners and simple tips for treatment and prevention. 1. Heel Pain and Plantar Fasciitis: Plantar fasciitis is caused by excess stress on the ligament-type structure within the arch of the foot. The tearing causes inflammation and the inflammation causes pain, most commonly at the inside of the heel. Over million runners develop plantar fasciitis each year. Although classic plantar fasciitis pain occurs at the heel upon stepping down first thing in the morning, this is not always true for runners. Many runners experience pain on the bottom of the heel and through the arch during the first 10-15 minutes of a run. In most cases, it works itself out as the run progresses, but returns at the end of the run, or later in the day. To prevent the development of plantar fasciitis when running or to help avoid re-injury, pay special attention to your shoes. Check your shoes for support and make sure they do not fold in the middle. Take the heel of the shoes and press the toe of the shoe into the floor. If the foot collapses under this pressure, it is much too flexible. A short run in an old pair of shoes can cause plantar fasciitis to development. Throw out old shoes when they are worn out and test all new shoes with this simple test. make sure your shoe is supportive. Just one run in that old, worn out pair of shoes can cause enough stress on the plantar fascia to start the process. If you are prone to developing arch pain or plantar fasciitis, stretch the arch before you run for at least one minute. Place one foot on the opposite knee while seated and grab the toes. Pull both the ankle and toes back. This will stretch the arch and you should be able to palpate the plantar fascia. Perform this stretch after the run as well. Calf stretching will also be beneficial, but if not done appropriately, can lead to Achilles problems. Warm up first, then perform calf stretches. Repeat the stretches when you are finished. Slowly progress with training by adding in distance and hills gradually and increasing pace and stride gradually. 2. Achilles Tendinitis: Achilles tendinitis and calf related injuries are the most common injuries experienced by runners. Pain may gradually develop at the back of the heel or calf, or come on suddenly as a sharp pain. Pain at the beginning of a run is common as well as pain and stiffness when first stepping down in the morning. Improper training, over training and poor footwear are the three most common reasons for development. A sudden increase in distance or pace or additional of steep hill climbs can strain the muscles and tendons in the foot and ankle causing microtears within these structures, resulting in pain and inflammation. Prevention for Achilles tendinitis and calf problems is similar to that of plantar fasciitis. Appropriate shoes and training are the most important. Calf stretching should be done after a 5-10 minutes warm up and it’s important to note that improper stretching or over-stretching can cause injury. 3. Stress fractures: A stress fracture is an incomplete break in the bone. In the foot, the long bones (metatarsals) are the most commonly affected. A sudden onset of pain and swelling on the top of the foot is an indication of a stress fracture. Stress fractures are generally not associated with blunt trauma or a specific injury, but are more often linked to unsupportive shoes in combination with overuse. Individuals with flatfeet, overpronation, hypermobility and tight calves are at the greatest risk. Those with very flexible feet tend to overstress the ball of their foot because the great toe joint tends to rise (hypermobility) during the push off phase of walking. The great toe joint does not take it’s fair share of weight and a greater force is placed on the smaller metatarsal bones. Individuals with tight calf muscles have a heel that lifts earlier than normal when walking. This also places excess stress on the ball of the foot and lesser metatarsals. Hypermobility and tight calves are linked to overpronation and this triad of abnormal foot mechanics, in combination with poor quality shoes and overuse can lead to stress fractures. Supportive shoes, heel lifts, orthotics (if necessary), proper training and stretching are the keys to avoiding stress fractures. 4. Ankle Sprains: Ankle sprains are a common injury experienced by runners. The most common injury is called an inversion ankle sprain and involves the ankle rolling out while the foot turns in. This causes a partial tearing of one or more of the ligaments on the outside of the ankle. Most ankle sprains are mild to moderate in severity, but some may be severe and involve complete tearing of the ligaments. Rest, ice, compression, elevation and early range of motion are the keys to treating most ankle sprains. Mild ankle sprains will need 2-6 weeks of rest and support, while moderate ankle sprains may take 6-12 weeks to heal. Severe ankle sprains will take 12 weeks to a year to heal and some involve surgery. An evaluation by a physician may be important to rule out a fracture or complete ligament tear. 5. Blisters: Almost all runners have experienced blisters and although they may not be as limiting as other running injuries, they are annoying at best. Blisters develop as a result of friction and shearing forces on the skin. Abnormal motion in the foot, such as pronation, excess moisture on the feet or within the socks, ill fitting shoes and foot deformities all increase the chance of blisters forming. The body’s natural defense mechanism to excess rub, irritation and shearing forces on the skin is to develop fluid between the outer layers of the skin. This provides a cushion and protects the under layers, allowing for a new layer of skin to grow. Blisters can be prevented with proper fitting shoes and appropriate socks. Finding the right combination of shoes and socks can be a challenge. Socks should be made of a wicking material which facilitate the transfer of moisture from your feet to the outer layer of the sock, so it can evaporate. Cotton socks absorb moisture like a sponge and should be avoided. The American Academy of Podiatric Sports Medicine recommends socks made with CoolMax. Shoes with mesh fabric allow for breathability and help with moisture evaporation. Supportive shoes with proper fit are important to avoid excess movement in the shoe. If you have orthotics, make sure you run with them, as excess pronation and abnormal foot motion are also factors causes friction, shearing on the skin and contribute to blister formation.

Achilles was the Trojan war Hero made famous by Greek Mythology. He was dipped into the river Styx by his mother, in an attempt to protect him in battle and make him immortal. Unfortunately he was struck by an arrow in the one spot at the back of his heel that she missed when she dipped him in the magical river. The Achilles tendon, which connects the powerful calf muscle to the back of the heel, now bears his name. Runners, athletes and Achilles are all similar in the vulnerability in this area. Without this tendon (which happens to be the largest and strongest in the body) running, jumping and athletic activities would be severely hampered. Anyone can develop Achilles tendonitis. It is a common, but preventable (and treatable) overuse injury of the tendon.
If you are out running hills and feel a sharp pain or dull ache in the back of the leg down near the heel, this could be Achilles tendonitis. If you feel along the course of the tendon (where it is mobile just above your heel bone) and you have tenderness, this is most likely Achilles tendonitis. Don’t ignore this. Ice the area and decrease your activity level. Avoid hills or speedwork until it subsides. If it doesn’t quickly get better, see your podiatrist. Otherwise you might end up sidelined for four to six weeks.
One of the most effective ways to prevent injury to the Achilles tendon is through a good warm-up and stretching routine prior to long runs, hill repeats and speed workouts. This keeps the tendon pliable, preventing micro-tears. Stretching can improve blood flow, enabling a speedy recovery if you do become injured. Stretch after a short warm-up; you should avoid aggressive Achilles stretches when your muscles are cold.
Patients with Achilles tendinitis often report a sense of sluggishness in the leg, diffuse pain around the Achilles tendon, or mild pain either during or after exercise that usually worsens as they run. Other symptoms can be swelling, morning tenderness in the Achilles tendon, or stiffness at the back of the leg that generally diminishes as the tendon warms up with use.
The severity of the injury to the Achilles tendon will help determine the treatment. But in most cases, rest is part of the treatment. It might be necessary to stop running and other high impact exercise, although often you can cross-train and cycle, as long as there is no pain or stress to the healing tendon. Treatment can also include non-steroidal anti-inflammatory medication or orthoses, which are devices designed to help support the muscle and relieve stress on the tendon, such as a heel pad or shoe insert.
Other treatments are bandages specifically designed to restrict motion of the tendon, stretching, physical therapy, massage, ultrasound and appropriate exercises to strengthen the weak muscle group in front of the leg and the upward foot flexors that work against the Achilles tendon. If the tendonitis is mild, simple modifications of activities may help. Decreasing mileage, running on flats instead of hills, and backing off the activity level until there is no pain with exercise can allow the tendon to heal. In general, ice is much better than heat for tendonitis.
Some medications can increase the risk of Achilles tendon ruptures (complete tear). Whenever taking medications such as oral steroids or antibiotics (prednisone, Cipro, Levaquin, etc.) you should not exercise unless you have discussed this with your treating doctor. You may have seen in the news where the FDA recently posted a strong “Black Box” warning about these antibiotics and the associated risk of tendon ruptures.
A torn Achilles tendon is serious. Interestingly, it is not always painful. However, there is usually significant weakness and difficulty standing up on the toes if this has occurred. Any suspected torn tendon can be serious and should be evaluated by a podiatrist. In rare cases surgery may be needed to repair the tendon.
If you happen to be a marathon runner in training for battle on the course; warm up before you stretch, but most of all, don’t deviate from your training program. Do not run through the pain if you think you have Achilles tendonitis. If you are a Trojan War hero in battle, and you see any arrows coming your way, stay low and keep moving!