Runner Wants to Avoid Achilles Tendon Injury

Q:  I am a healthy 40-year-old athlete getting ready to run the Boston Marathon in the spring of 2007. I want to train right and do the best I can, but I also want to be free of injuries.

Right now my right Achilles tendon aches whenever I run (I usually go about 5 miles). Can I just train through this pain, or must I rest? I'd appreciate any training advice.

A:  The Achilles tendon is the firm band you can feel connecting the back of your heel to your calf. Dr. Mark Niedfeldt, Associate Professor of Family and Community Medicine and a sports medicine specialist at the Medical College of Wisconsin, notes that problems with the Achilles tendon occur in about 10% of runners, especially as they increase running mileage when training for marathons.

Treatments may take many forms: a gel heel lift (which is found at most pharmacies), strengthening exercises, calf stretching and icing after your runs, anti-inflammatory medications, and night splints (to be prescribed by a doctor).

One good exercise for the problem is to:
1. Stand with your heels hanging off a step.
2. Rise onto your toes.
3. When fully on your toes, lift the good foot up so all of your weight is on the sore foot.
4. Slowly lower this foot as far as you can (below the line of the step).

Repeat this exercise for 3 sets of 10 repetitions. You may ache a bit after starting; but that's normal.

But can you continue to run with an Achilles problem? It depends on whether or not the problem is worsening as you continue to run. According to Dr. Niedfeldt, "if it is a bit stiff when you begin running but loosens up and doesn't bother you otherwise, it is probably okay to continue to train. If it is worsening and bothers you during the day as well, you may need to back off for a period of time."

If the pain continues to worsen despite rest, see your physician, who may recommend physical therapy or orthotics.

A list of good running stretches is available through the American Academy of Family Physicians patient information website.

Julie L. Mitchell, MD, MS, is an Assistant Professor of Medicine at the Medical College of Wisconsin. She practices at the Froedtert & The Medical College of Wisconsin General Internal Medicine Clinic - East. Her column appears in the Milwaukee Journal-Sentinel.