From the Guidelines
To manage your right heel pain suspected to be Achilles tendinopathy, immediately reduce your running mileage by at least 50% and switch to supportive footwear with arch support and a wide toe box. This approach is based on the understanding that Achilles tendinopathy is common among adult runners, with factors such as improper technique, anatomic misalignment, and improperly fitted footwear contributing to its development 1.
Given the multifactorial etiology of Achilles tendinopathy, a comprehensive treatment plan is necessary. This includes:
- Reducing running activity to decrease mechanical stress on the tendon
- Wearing appropriate footwear to correct issues such as overpronation or pes planus, which can exacerbate the condition
- Implementing eccentric strength training, such as calf raises, which has been shown to be effective in treating Achilles tendinopathy 1
- Stretching exercises, like those targeting the gastrocnemius-soleus complex, to improve flexibility and reduce tension on the Achilles tendon
- Applying ice to the affected area for pain relief, especially after activity
It's also important to consider anatomic misalignments and address them with shoe orthotics if necessary. Heel lift orthotics can provide additional pain relief by unloading the tendon 1. While the evidence from 1 suggests various initial treatment options, the most recent and highest quality guidance from 1 emphasizes the importance of conservative treatment including eccentric strength training and addressing anatomic issues, making it the preferred approach for managing Achilles tendinopathy and improving quality of life by reducing morbidity and mortality associated with prolonged tendon injury.
From the Research
Reduction in Running Mileage
- Reducing running mileage is recommended to alleviate symptoms of Achilles tendinopathy, as increased running activity is a known risk factor for the condition 2.
- Studies have shown that activity modification, including reducing running mileage, can lead to improvement in symptoms and function in patients with Achilles tendinopathy 3.
Appropriate Footwear
- Wearing appropriate footwear with arch support and a wide toe box is recommended to reduce stress on the Achilles tendon 2.
- Orthotics, such as arch supports, can be used as a conservative treatment for Achilles tendinopathy, although the evidence for their effectiveness is moderate to low 4.
Calf Raises and Stretching Exercises
- Calf raises and stretching exercises, particularly eccentric exercises, are recommended to improve function and reduce pain in patients with Achilles tendinopathy 2, 5, 6.
- Eccentric exercise has been shown to be effective in reducing pain and improving function in patients with Achilles tendinopathy, and is considered a first-line treatment for the condition 6, 4.
Icing for Pain Relief
- Icing can be used as a pain relief measure for Achilles tendinopathy, although the evidence for its effectiveness is limited 2.
- Other pain relief measures, such as nonsteroidal anti-inflammatory medication and corticosteroid injections, may provide short-term relief but are not effective in the long term 2.