THE CLINIC: Bad Shoe Fit Can Lead to Achilles Irritation

QUESTION:

Several months ago my Achilles tendon started bothering me. I noticed that the soreness was where the upper part of my shoe rubbed on the tendon. So I cut the shoes to try to prevent further rubbing and put heel lifts in. But I am still having trouble. Now there is a little bump there. Is there anything else I should do?

Margot Weimer

Boston, MA

ANSWER:

Most running shoes are made with an Achilles notch to prevent irritation to the tendon. The irritation, which may be minor at first, can escalate into a major problem. First, stop running and see a sports physician familiar with runners. If there is a bump or thickening in the tendon, there may be chronic inflammation with scar tissue, degeneration, or even a partial tear, with real risk for an Achilles tendon rupture. An MRI should help with diagnosis and treatment, which will necessitate rest and may include physical therapy. If the injury is severe, surgery may be required. This is not something to ignore.

Patrick J. Nunan, DPM

West Chester, OH

Pistoning of the foot in the shoe—this is the back and forth sliding motion of the foot inside the shoe—can exacerbate Achilles tendon irritation. Try a tongue pad glued onto the back of the shoe tongue (available at specialty shoe stores). When glued to the foot side surface of the shoe tongue, along with tight lacing, the back and forth movement of the foot can be reduced.

Marvin Bloom, MD

Burlingame, CA