Tendinitis? Change your routine -- and your shoes

I’ve been recently diagnosed with Achilles tendinitis. What happens to the Achilles tendon when I’m running? I’m 50 years old and was averaging 35 to 40 miles per week. Is it advisable to ever treat it with heat?

PHIL

Santa Fe Springs

The Achilles tendon connects the calf muscle to the back of the heel bone, and is a sore spot (literally) for many runners. Since the Achilles is used to propel the foot up and off the ground, it’s subject to a great deal of stress, sometimes causing inflammation and intense pain when walking or running.

Two major factors can lead to tendinitis, says Dr. Bob Baravarian, chief of podiatric surgery at the Santa Monica-UCLA Medical Center and director of the Foot and Ankle Institute of Santa Monica. One is abnormal motion of the foot, either rolling too far inward or outward. “This causes spasming of the Achilles as it tries it stabilize the foot,” he says, “and that results in the tendon getting irritated from overuse.”

The other is changing something about your routine or shoes that would cause the Achilles to overstretch: upping your mileage too quickly, running hills instead of flat ground, running on sand instead of hard surfaces or going from a highly cushioned shoe to one with far less stability. “Those,” he says, “can cause the tendon to become inflamed because it’s overworked.”

Baravarian says your first line of defense should be to see if any of these factors apply to you. If you’re running a lot of hills, go back to flat ground and add inclines gradually. Try different shoes, especially if yours are old and worn.

Other plans of action include icing your ankle twice a day for about 10 minutes to reduce inflammation, preferably after a run. Applying heat, he says, may temporarily increase blood flow to the area, but in general won’t help much.

You can also try an orthotic (start with an over-the-counter variety) to increase your foot’s stability inside the shoe. Massaging the tendon may help break up any scar tissue, but if this is painful, stop.

You can also do some mild stretching after warming up -- for the classic Achilles stretch, start by leaning against a wall, with one foot in front of the other. Gradually push the back heel down, then slightly bend that leg. Don’t force the heel down, however; you may end up doing more damage.

Although many hard-core runners find it difficult to completely stop, try temporarily switching to another pursuit that doesn’t entail as much impact, such as cycling or using the elliptical trainer. At the very least, cut back on your mileage for a while.

If none of these remedies work, it may be time to go to your doctor for a treatment such as ultrasound or massage therapy.

-- Jeannine Stein

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