Why Does My Achilles Hurt When I Run? 7 Causes and Fixes

If you're a runner, "Why does my Achilles hurt when I run?" might be all too familiar. That nagging pain at the back of your ankle is enough to throw any runner off their stride. Achilles tendinitis is a common overuse injury, especially as we get older. Knowing the causes and symptoms is the first step to finding relief and returning to the active lifestyle you love.

Sometimes it's a mild ache that slowly worsens. Other times, it's severe enough to sideline you completely. Seeking professional help from an experienced podiatrist in Centreville, VA, like Dr. James Hurst can help ease that pain that interferes with your daily life.

What Is Achilles Tendinitis?

Achilles tendinitis is an overuse injury that happens when your Achilles tendon becomes inflamed and painful. This large tendon connects your calf muscles to your heel bone and plays a role in running, jumping, and pushing off with your toes. As we age, tendons naturally lose some elasticity, making them more susceptible to damage, especially with vigorous activity.

Think of your Achilles tendon as a hard-working rope. When you suddenly increase your mileage or intensify your workouts, you put a lot of strain on that "rope." Over time the fibers can fray, causing inflammation, pain, and stiffness. This is what we call Achilles tendinitis. You need to know the difference between Achilles tendinitis and other foot or ankle problems to get the right treatment.

7 Causes of Achilles Pain When Running

We all know the exhilaration of a new running program, the excitement of pushing yourself a little further each time. But sometimes, that enthusiasm can lead to trouble. Let’s look at seven causes of Achilles pain below:

Cause #1: Overuse and Repetitive Strain

The most common culprit behind Achilles pain is pushing your body too hard, too fast. When you suddenly increase your mileage, add intense hill workouts, or ramp up your speed training without proper conditioning, you're overloading your Achilles tendon beyond its current capacity.

This is common for those who participate in sports only on the weekends, also called the "weekend warrior" syndrome. Your Achilles tendon needs gradual adaptation to handle increased demands. If you don't give it that time, those repetitive stresses can lead to tiny tears and inflammation, ultimately causing the pain you feel.

Cause #2: Improper Running Form

How you run plays a major role in Achilles' health. If your stride is off, it can place excessive stress on your tendon with every step you take. Common issues like overpronation (when your foot rolls too far inward) and heel-striking (landing heavily on your heels) can put a tremendous strain on the Achilles.

It’s like driving a slightly misaligned car. Over time, that misalignment causes uneven wear on your tires. The same principle applies to your body. If your running form isn't optimal, certain muscles and tendons take on more of the burden, leading to potential injuries like Achilles tendinitis. A running form analysis can often pinpoint areas to reduce this risk.

Cause #3: Inadequate or Worn-Out Footwear

Your running shoes are your Achilles tendon's best friend or worst enemy. Shoes that lack proper support, don't fit correctly, or are past their prime can increase your risk of Achilles pain.

Think of running shoes as shock absorbers for your body. When those shock absorbers wear down, the impact from each stride travels straight up your legs, putting additional strain on your Achilles. Similarly, running in shoes that don't support your foot type can lead to misalignment, further stressing the tendon.

Cause #4: Tight Calf Muscles

If your calf muscles feel tight, your Achilles tendon is paying the price. When your calf muscles lack flexibility, they pull on the Achilles tendon with every step. This constant tension can lead to inflammation and pain, causing Achilles tendinitis.

Your calf muscle and Achilles tendon are a connected unit. If one part of that unit is tight and inflexible, it puts extra strain on the other part. Regular calf stretching can help prevent Achilles issues, especially as the natural elasticity of our muscles and tendons decreases with age.

Cause #5: Sudden Increase in Running Intensity

While enthusiasm for running is great, ramping up your training too quickly is a recipe for trouble. Suddenly adding a lot of mileage, incorporating intense hill workouts, or increasing your speed puts immense stress on the Achilles tendon before it has time to adapt.

Tendons need gradual, progressive loading to get stronger. If you don't allow this adaptation time, the sudden increase in demand can lead to irritation and inflammation.

Cause #6: Underlying Medical Conditions

Sometimes, Achilles pain isn't just about your running habits. Certain underlying health conditions can increase your risk of Achilles tendinitis. These include psoriasis, high blood pressure, and the use of certain antibiotics (fluoroquinolones).

If you have any of these conditions, you should discuss how they might be affecting your tendons. Your doctor or a podiatrist can help you develop a safe and effective exercise plan that takes your overall health into account.

Cause #7: Ignoring Early Warning Signs

Achilles tendinitis often starts subtly. You might feel a mild ache after a run that disappears with rest. It's tempting to ignore these early signs and hope the pain goes away. However, trying to "run through" Achilles discomfort can turn a manageable issue into a more serious, longer-lasting injury.

Pay attention to your body. If you consistently feel pain in your Achilles after running, it's time to take a step back and address the issue. Early treatment often leads to a faster and less complicated recovery, preventing you from being sidelined in the long run.

How To Recognize Achilles Tendinitis

Knowing the classic signs of Achilles tendinitis helps you determine if that's what's causing your pain. Look out for these common symptoms:

• Pain and stiffness along the back of your ankle, especially after running or other activity. This pain might worsen throughout the day.

• Morning stiffness that may lessen slightly with movement.

• Tenderness, swelling, or a feeling of warmth around the tendon.

• Occasional cracking or snapping sensations when you move your ankle.

If you experience these symptoms, ask for professional advice. While these signs point toward Achilles tendinitis, a proper diagnosis helps rule out other potential injuries and ensures you receive appropriate treatment.

What To Do if You Experience Achilles Pain While Running

If you feel a sharp pain in your Achilles or any discomfort that forces you to alter your running form, stop running immediately. Continuing to push through can worsen the injury.

Seek professional help, especially if the pain is severe, persistent, or limits your daily activities. A podiatrist can diagnose the issue and guide you through a treatment plan for a safe recovery.

While you wait for your appointment, try these at-home remedies:

RICE Therapy

RICE stands for Rest, Ice, Compression, Elevation. This is a foundational approach for many soft tissue injuries, including Achilles tendinitis. 

• Rest: Avoid activities that put stress on your Achilles, especially running. Consider low-impact exercises like swimming or cycling while your tendon heals.

• Ice: Apply ice packs wrapped in a thin towel to the affected area for 15-20 minutes at a time, several times a day. Don't apply ice directly to your skin to avoid irritation.

• Compression: Consider using a compression bandage to provide gentle support for the tendon. Consult your doctor for proper wrapping techniques.

• Elevation: If possible, elevate your ankle above your heart level to reduce swelling.

Seek Professional Help

Don't hesitate to schedule an appointment with a podiatrist, especially if:

• The pain is severe and limits your daily activities.

• The pain persists for more than a few days despite home remedies.

• You suspect a complete Achilles tendon tear (sudden, intense pain with a popping sensation and an inability to bear weight on the affected foot).

• You have pre-existing medical conditions like diabetes or peripheral neuropathy. These conditions can affect wound healing and require close monitoring during recovery.

Additional Considerations for Runners Over 40

As we age, our bodies take longer to heal. Be patient with your recovery process. Listen to your body and gradually return to running activities only after getting the green light from your podiatrist.

Here are some additional tips to keep in mind:

Open Communication With Your Doctor

Be transparent with your podiatrist about your running goals and activity level. They can create a personalized treatment plan tailored to your needs.

Physical Therapy

Your podiatrist might recommend physical therapy to improve flexibility, strengthen surrounding muscles, and promote tendon healing.

Modification of Running Technique

A podiatrist can assess your running form and suggest adjustments to reduce stress on your Achilles tendon.

Wear Supportive Footwear

Invest in proper running shoes with good arch support and cushioning specifically designed for your foot type.

Remember, early intervention and a proactive approach can help in Achilles tendinitis recovery. Don't let fear of going to the doctor prevent you from getting the treatment you need to get back to running pain-free.

How To Prevent Achilles Tendinitis

The best way to deal with Achilles tendinitis is to prevent it from happening in the first place.  Follow these tips to minimize your risk:

Increase Mileage Incrementally

If you're starting a running program or ramping up your current routine, go slow and steady. Avoid sudden increases in mileage, speed, or hill work. A good rule of thumb is to increase your weekly mileage by no more than 10%.

Prepare and Recover With Stretching

Make dynamic stretches (like leg swings or gentle lunges) a part of your pre-run routine. After running, focus on static stretches that target your calves and Achilles tendons.

Mix Up Your Workouts

Instead of just running, mix in low-impact activities like swimming, cycling, or elliptical training. This reduces repetitive stress on your Achilles and builds overall fitness.

Strengthen Your Support System

Calf raises and eccentric calf exercises (slowly lowering your heel over the edge of a step) can strengthen the muscles and tendons that support your ankle.

Get the Right Gear

Replace worn-out running shoes and consider a professional fitting at a running store. If you have overpronation or other foot issues, your podiatrist may recommend supportive shoes or custom orthotics.

Listen to Your Body

Don't push through pain. If you feel those early twinges in your Achilles, take a step back, rest, and ice the area.

Remember, prevention is an ongoing process. By consistently adding these strategies into your routine, you can keep your Achilles tendons healthy for a long time.

Treatment Options for Achilles Pain

While rest and home remedies are important initial steps, sometimes you need more advanced treatment to get back on your feet. Here's a brief overview of what you can expect:

Rest and Reduced Activity

Even with professional treatment, giving your Achilles tendon adequate rest is still required for healing. Your podiatrist will recommend how much to reduce your activity level based on the severity of your injury.

Physical Therapy

A physical therapist can design a personalized exercise program that includes stretching, strengthening, and modalities like ultrasound therapy to promote healing and reduce inflammation.

Orthotics or Heel Lifts

If misalignment in your feet is contributing to Achilles strain, custom orthotics or simple heel lifts can often provide correction and relief.

Medication

In certain cases, your doctor may discuss anti-inflammatory medications to help manage pain and swelling.

Achilles Pain Slowing You Down? Get Back on Track Now

The nagging question "Why does my Achilles hurt when I run?" can be incredibly frustrating. Know that you're not alone in this journey. Understanding the potential causes is a great start, and in many cases respond successfully to self-care and preventative changes.

However, if the pain won't let up, or if you desire individualized guidance, Centerville Foot & Ankle & Sports Medicine is your partner in recovery. Dr. James Hurst will work with you to develop the best treatment plan to address your situation and get you back to doing what you love.