Ask the Doctor: How Does Achilles Tendonitis Develop From Just One Bad Run? (2024)

Q: Two weeks ago I ran in a new pair of sneakers. I had run in them one time previously with no problems. I felt a pain on top of me foot like a pressure point and adjusted my laces but it didn’t help. I ran 6 miles anyway and while the top of my foot had pain due to the pressure point, my heel was fine. My ankle also was a bit stiff but no heel pain. The next day the top of my foot was sore from the pressure point but that is all.

Two days later I tried to run and couldn’t due to intense pain in my Achilles. I was in total surprise that I had such pain in my Achilles area and even walking was painful. Walking uphill was especially painful. I had no warning of this – no pain waking up in the morning, no pain just walking at work – just the slight pain on top from the pressure point.

I tried a trail run a few days later as its a softer course and I wear trail runners. The pain wasn’t as intense, but it was there.

I have since taken two weeks off from running and I have no pain walking at work but if I squeeze my Achilles area I get a slight sensation – not sharp pain but pain. I have no idea what to do as this can’t be an overuse injury and I have been running 10 years with never an Achilles problems. I am not sure when should I try to run again. I don’t want this to get out of control.

If it is tendinitis, how does the condition develop from just one run?

-- Diane, NJ

A: Achilles tendinitis can develop in runners of all abilities, even seasoned veterans. Running with foot pain (pressure point) most likely caused you to alter your gait; this would account for the ankle stiffness that you were experiencing at the end of your run. It’s a little surprising that you did not experience discomfort when you got out of bed the following morning, but if you were still modifying your gait due to pain from the pressure point, you may not have stressed the Achilles tendon enough to cause pain.

Typically, tendinitis does not develop from one bad run, but is the culmination of months (or years) of repetitive microtrauma. It adds up over time and it is not uncommon for someone to suddenly present with tendinitis. A slight change in gait or change of footwear may be enough to cause the symptoms to occur.

With that said, you need to keep in mind that you have over 1000 footstrikes per mile (often 1500 strikes). If any part of the lower extremities (especially the foot and ankle) is even a little weak, problems will develop over the course of several miles.

Running will put the tendon through a much greater range of motion and stress. Uphill activities definitely stress the tendon. The heel counter of your new sneakers (hopefully you are referring to running shoes) may irritate your Achilles tendon. This may account for less pain wearing your trail shoes.

Now that you don’t have pain with walking, you need to work on flexibility and strengthening of the Achilles tendon. Hang your heels off of the edge of a step (you should feel a stretch, but not pain). Hold this position for 10-20 seconds. Then bend your knees a little and hold this position for 10-20 seconds. If you have no pain with stretching, you may start strengthening exercises. Hang you heels off of the edge of a step. Rise on your toes and then lower the heels. Perform 30 reps and increase to 50. When you are comfortable with this, increase the speed of the reps. When you are comfortable with this, start performing the exercise on one leg, starting slowly and gradually increasing speed as strength improves.

Apply ice to your Achilles tendon following all activities.

Your running shoes may be a major source of the problem; running in them again may cause problems.

Start by running a couple of miles and if you are pain free, gradually build your base again.

Work on the strength and flexibility and the problem should resolve; maintain the strength and flexibility and the problem should not recur.

-- Dr. Cathy Fieseler