posted on 24 Mar 2014 12:45 by nathe13

Barefoot running, Achilles tendonitis, and my recovery story « The Equity KickerThe Equity Kicker

Six months ago my achilles were trashed. The combination of low level pain and fear of making them worse meant that riding my bike or running were both out, and I could only walk at a snail's pace - maybe 25% of my normal walking speed. I was having to get taxis everywhere (which I hate) and/or leave much longer to get between meetings. Probably worst of all I couldn't play properly with my kids.

By that time I had been struggling with Achilles tendonitis for three to four months, with it getting better and worse in repeated cycles, and whilst I always thought I would improve significantly from that low point I was worried that my tendonitis was chronic and would stay with me for life. I talked to a lot of people about my ankles during that time (as you can imagine) and there were a surprising number who had been through a similar experience without fully recovering.

The good news is that I'm better now. A number of people asked me to write about it if I did make a full recovery, and this is that post. I've been thinking that my Achilles are fully recovered for a couple of weeks now but decided to leave it a little while before writing about it, just to make sure. And I was sure, but writing this has sewn some seeds of doubt in my mind. I hope I don't have to return to this topic again.....

My problems started last November when I bought a pair of Vibram FiveFingers shoes and switched to the barefoot running technique. I'd read Tim Ferriss's book The 4-Hour Body over the summer and got sold on the benefits of eschewing big fat cushioned trainers for very lightweight shoes that make you run as nature intended, mostly because barefoot running is easier on the knees. I studied up beforehand and learned that the transition from running in normal trainers with a heel strike to running in Vibram's with a forefoot strike was difficult and should be taken slowly, so I spent a couple of months forefoot striking in my old trainers and then took it a bit easy when I switched to the Vibram's.

But not easily enough.

I started getting sore Achilles, but because the pain was a low grade ache that felt like muscle tiredness I mostly ignored it. Over a period of time it got worse, and the pattern of pain shifted so that it was worse in the mornings, just after I'd woken up. I subsequently learned that soreness in the morning is the classic sign of Achilles tendonitis. Still, at this point it wasn't too bad and I assumed I just needed to train more so that my ankles got stronger and I was fully adjusted to the new shoes.

Bad mistake. A month or so later of running 5km a couple of times per week (note: these are not long distances) I reached my nadir, as described in the opening paragraph.

At this point I did what I should have done some time before and went to see a physio, and maybe three months after that the tendonitis was all but gone, and now I'm running my 5km twice a week in the Vibrams with no ankle problems at all. Moreover, I'm loving the barefoot running, it really is much easier on the knees. When I used to heal strike I could feel the joints in my legs taking the impact as the full weight of my body dropped and was pushed back up again with each stride. Running barefoot there is much less up and down motion and the weight that is cushioned is cushioned in the calf muscle rather than the knee joint.

Looking back, I think I did three things wrong:
Underestimated the difficulty of the transitionAdopted a poor barefoot running techniqueMade the mistake of thinking that because the pain in my Achilles wasn't severe I wasn't doing much damage
My recovery had two components.

First was rest. My physio explained how the Achilles work, and what puts load on them. It turned out that I was loading my Achilles hard just about all day every day - by cycling, walking fast, going up stairs two steps at a time, playing little running games with the kids, jumping up and down at football games, and a myriad of other little things like that. Once I understood how much I was working them I was able to minimise the load they experienced.

Second was to build up their strength. This was a very long and tedious process. To start with it the daily time commitment was minimal - a small number of exercises each day (heel lifts on the edge of a stair taking some of my weight with my arms, 3 sets of six reps twice a day) but there was no tiredness afterwards and it didn't feel like the exercises were doing anything. I did my exercises twice every day, three days on and one day off with a slow increase in the load getting up to 3*12 reps on one leg with 20kg on my shoulders over six weeks or so, and by the end it was quite time consuming (although it was clear I was getting stronger). Only after that was I allowed to start running again, and once again I started slowly. My first run was only two or three minutes and I added two minutes or so each time I ran getting up to the 25mins or so I take for my morning 5km now.

I made pretty steady progress through this period, but there were a few minor setbacks. Advised by my physio I kept a constant check on whether my Achilles were sore in the morning. A small amount of stiffness was ok, but anything more than that and I rested for a day or two and took my heel lifts or running back to the level it had been the last time I had exercised and not got a reaction the morning after. I think all the setbacks came because I over-estimated the progress I had made, which is very easy to do because the Achilles don't hurt when you are damaging them in the way that the rest of the body does.

In addition to the above my physio gave me weekly massages and had me do a bunch of other exercises which improved my posture and balance. And then before I started running again I watched lots of videos of barefoot runners and improved my technique (principally shortening my stride and kicking my ankles up towards my backside as soon as my foot strikes the ground).

So I think I've learned a few things from this experience:
For me at least the barefoot running is much better than wearing chunky trainers and heel striking (here is a pretty good list of the pros and cons)The transition to barefoot running is difficult and takes a lot of patience - injuries are common, so if you're going to give it a go, be carefulAchilles tendonitis is a more curable condition than many people think - I may simply have been lucky, but from my own experience and that of my physio my feeling now is that there are probably others out there suffering with chronic tendonitis who could get better. They keys are a lot of patience in building up the strength of the Achilles tendon and a lot of diligence in not returning to sport too early (even when it isn't hurting much).

Ankle Pain and Injures

posted on 20 Mar 2014 06:31 by nathe13

Ankle Pain and Injures

Ankle Pain Disorders and Injuries of the Ankle
The ankle joint is comprised of the lower leg bones, the tibia and the fibula, meeting with the talus bone of the foot. The ankle joint is considered a "hinged joint" and moves primarily in two directions, toward and away from the body, with very little side to side movement. Surrounding the joint are ligaments, which serve to connect the lower leg bones to the ankle bone, providing support and stabilization. The ankle is moved by muscles and tendons.

Sprains and fractures are the most common problems associated with the ankle joint and are usually a result of a sport injury. When a ligament is injured, it is known as a sprain. Ankle sprains can take as long as months or a short as weeks to heal properly. When the bone is broken, it is a fracture, described as simple or compound, and may need to be manipulated by a medical professional before healing will begin. Injuries to other parts of the ankle joints, such as cartilage can also occur which affects the cushioning and lubrication between the bones of the ankle joint. Injury to the tendons is know as tendonitis, which affects the muscles surrounding the ankle joint.

What are the main causes of ankle pain?

When a ligament is suddenly stretched, the result is either a partial or complete tear, known as ankle sprain.An ankle sprain can happen to either or both sets of inner and outer ligaments surrounding the ankle joint. Ankle sprains are more likely to occur if there has been a previous ankle injury or a preexisting muscle weakness in the ankle. Ankle sprains can occur from participation in a vigorous physical activity known as a sport injury or something as mild as stepping onto an uneven surface. The ankle can be twisted and results in the ligaments stretching suddenly, causing an ankle sprain. Patients often describe a ankle sprain as a popping sensation when the ligament is torn. Following the popping sensation onset swelling and pain occurs in the ankle. Swelling is caused by the blood vessels that have been injured leaking fluid into the surrounding tissues. Ankle sprains have three categories for the severity of the ligament tears, graded from I to III, I being a partial tear and III being a complete tear. For ankle sprains that are in the III category it is usually suggested that ankle surgery is performed, especially for patients that want to participate in athletic activity in the future. Ankle sprains that are more severe are sometimes accompanied by a fracture of the ankle bone. Fractures can be repaired with a cast to keep the ankle joint immobile for proper healing. Ankle fractures can also require surgery to repair damage, depending on the severity of the break in the ankle bones.

Inflammation of tendons can also cause ankle pain and is commonly known as tendonitis. There are three main tendons in the ankle, the Achilles tendon, the peroneal tendon, and the posterior tibial tendon. Tendonitis usually occurs from trauma to the tendons in the ankle, but can also stem from unknown, previously occuring inflammatory diseases. In either case, all forms of tendonitis cause swelling, tenderness and ankle pain. Sometimes the onset swelling and pain may be rapid, like ankle sprains involving physical activity, that need immediate treatment which includes elevation, immobilization, a cold compress or ice being applied to the area, and use of anti-inflammatory drugs to calm the swelling.

Ankle pain can also be caused by different types of arthritis, which is inflammation of the associated joint. Reactive arthritis, gouty arthritis, rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis are the main types of arthritis associated with ankle pain and inflammation of the ankle joint. Arthritis is not caused by a single incident or injury to the ankle joint, but develops slowly over time. The symptoms of these types of arthritis cause ankle pain including swelling, stiffness, warmth in the area, and redness.

Another condition that causes ankle pain is tarsal tunnel syndrome which results from the compression of nerves in the ankle joint as it passes under the flexor retinaculum, the supportive band surrounding the ankle joint.

While infections of the ankle joints are rare, bacteria can be introduced into the ankle joints through trauma, compound fractures or open wounds. Antibiotics are used to treat infections of the ankle joint, but patients with weak immune systems or diabetics are more likely to have bacterial infections in their joints.

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