Barefoot running, Achilles tendonitis, and my recovery story

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 transition
  • Adopted a poor barefoot running technique
  • Made 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 careful
  • Achilles 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).
  • http://freeradical.me/ kowsik

    +1 on the post Nic. I was diagnosed of both Achilles Tendonitis and Compartment Syndrome, but just 6 months after starting to run barefoot (and figuring out how to strengthen my calves, ankles and tendons) I ran my first half marathon. You might like this post I wrote up a few weeks ago: http://freeradical.me/2012/11/09/does-running-barefoot-make-you-a-tough-guy/

  • http://www.facebook.com/djhsquires Dan Squires

    its v straight fwd. take up proper cycling. more fun and less hard on the legs ! i am doing the same stuff …bit of running, squash and cycling and got v tight hammies, ITB etc. cycling is far superior! come and do the London revolution in May with me and some friends

  • http://www.theequitykicker.com brisbourne

    Use it or lose it Dan. My strategy is to do all types of exercise to make sure all my muscle groups and joints stay strong.
    Sent from my Android phone using TouchDown (www.nitrodesk.com)

  • Joe

    while you were recovering, did you wear regular, cushioned running shoes throughout the day, or did you continue to wear minimalist shoes with a low heel to toe drop?

  • http://www.theequitykicker.com brisbourne

    I only ever wear minimalist shoes when I’m running. The key during the recovery period was listening carefully to my body and being aware when I was putting too much load on my Achilles. For a long time that meant walking slowly with a modified gait that was easy on the ankles.

  • Lizette Rodriguez

    I experienced the same thing, but what I found that helped me through the recovery was to strengthen the muscles that aren’t traditionally used when running in shoes. I hope this helps you in anyway possible! :)

    http://teamdoctorsblog.com/2012/04/12/video-tutorial-171-barefoot-footprints-in-the-sand-what-they-can-tell-you-about-your-running-form-and-technique/

  • Michael Garrett

    I had Achilles tendonitis too and I really think it was because of my Nike shoes. It was really swollen and painful. I’ve been a painkiller dependent, tried different medications, seen by different doctors. I wasted a lot of money, yes, but I am glad that I didn’t stop looking for the appropriate treatment for me. I had stem cell treatment with Dr Grossman of Stem Md and it was successful. I was scheduled for 7 weeks therapy (I must admit that I had fever for few days after the treatment but the good things is that my tendons went back to normal and they are still working fine now despite the fact that I’ve added few mileage to my running goals. I am not sure if I will still use or buy Nike in the future… perhaps once I forgot the pain and the cost of curing my tendonitis.

  • http://www.theequitykicker.com brisbourne

    Wow. That’s the first time I’ve heard of stem cell treatment. Glad it worked for you.

  • Michael Garrett

    Yup. Thanks… No more joint pains for me… I just hope that the effect will last years and years more..

  • http://www.pwminor.com/cushion-knee-afo-sock-6pk.html Achilles tendonitis

    This is one inspiring article.. thanks

  • http://health.usnews.com/top-doctors/directory/best-in-oklahoma-city-ok Danial Garcia

    I had a feeling that going for minimalist shoes isn’t really the way to go if you want to strengthen your joints and prevent strain. Your Oklahoma doctor gave you the right exercises for strengthening your joints and calves.