In this video, I'm going to talk about a few considerations you might want to think about if
you are choosing a pair of running shoes when you have an Achilles tendon problem. My name is Steph.
I'm one of the physios at treatmyachilles.com, where you can get an online assessment for your
injury and an individualised rehab plan. If this is something that interests you,
then please take a look at the Description of this video, and the link to our website is in there.
So, when I talk about Achilles problems, for the purpose of this video, I'm talking about Achilles
tendon overuse problems such as tendinopathy, or sometimes people call it tendinitis,
possibly bursitis or Haglund's problems. And it's a common question we get asked as physios:
“What sort of shoes should I wear?” And the first thing I will say is, if you have a problem,
rather than just changing your shoes, you probably should get someone to look at it,
because there might be something very simple that you can do that will help sort it out.
And the sooner you sort it out, the quicker it gets better. If you try and do things that
don't work for longer, then it takes longer to get better. So, get it sorted as quickly as possible.
The second thing I would say before we delve into different types of shoes is that the shoe you
choose has to be comfortable. There's absolutely no point in going to run on a treadmill and have
a video taken, choose a perfect pair of shoes on paper, for you to hate them and never want to wear
them, which has happened to me in the past, which is why I say it. They've got to be comfortable,
because otherwise it defeats the whole purpose and is pointless, really. Anyway. So now we talk about
the drop, the millimetres of heel-to-toe drop that you'll see a lot of information about when you're
looking at a pair of running shoes. So, what we're talking about here is the difference in height
between the heel ... the sole of the shoe at the heel, versus the sole of the shoe at the forefoot.
And the drop is measured in millimetres. And you'll see for … like this is a Saucony Kinvara;
that's a four-millimetre drop, so that's fairly flat, actually. So, four millimetres still counts
as a fairly minimalist shoe. You quite often get people wearing the ultra zero-drop shoes. They're
very comfortable with the wide toe box; people like them a lot. They have a zero-drop shoe, which
means it is totally flat. The standard running shoe is probably about eight millimetre drop,
and you can get some that are even up to 12 mils. And the reason this is relevant for an
Achilles problem is, they know from kinematic and biomechanical research that the flatter the drop,
the more stress and load actually get put through the Achilles tendon, and to some degree,
the plantar fascia and the metatarsals and your calf. So, when you're running in a flat
or a zero-drop shoe, you naturally are requiring more of your Achilles tendon. So it doesn't mean
you can't get back to running in a zero-drop shoe, but it might take you longer to get the
strength and conditioning in your Achilles and your calf good enough to tolerate it,
if you had problems. Or, we commonly do see people who have developed problems because they do not
have the conditioning in the Achilles and the calf required to tolerate a zero-drop shoe. So,
it is relevant. The other thing about the zero-drop shoe is whether or not you have
enough range of movement in your ankle. So, for someone who has a very stiff ankle and can't
passively dorsiflexion it very far, you might actually be better with a little
bit of support to compensate for the fact that the ankle is stiff. For someone who has
lots of range of movement then you probably can tolerate the zero-drop shoe just fine.
The next thing to consider it's not then all about getting a really thick-heeled shoe,
because actually you want to consider the rest of your body, and everybody is a bit different. Some
people have issues elsewhere, so perhaps knee pain or hip pain or back pain. And the reason
zero-drop shoes are so popular is because it takes more load on your Achilles but takes
less load on some of the other body parts. So, it's no good trying to protect your Achilles,
going into a thicker-drop shoe, to find that you end up hurting your knees or something
else that has more strain on it as a result. The other thing to consider with Achilles is,
lots of different trainers have different sort of hardness of their heel cup, and if you're
not sure, you can have a feel of it. So, this is particularly relevant for people with bursitis.
I've noticed, certainly, some shoes come up quite high at the back now,
so that can actually physically dig into the mid-tendon, in your Achilles,
if you've got a problem. And then sometimes, it's quite – especially if shoes are getting a bit worn
out and are starting to come apart a little bit – you can get hard areas developing in the heel cup,
which can physically dig into the insertion area, or they can just … it can be stiff and squeezing
on the area, causing friction on the area. So, if there's like an actual physical reason that
the area is getting irritated, then it obviously needs to change. And the final thing I would say
about … If you put, for instance, some heel lifts into a trainer to try and increase that
drop and offload the Achilles, it can just push the heel up into the wrong bits of the shoe. So,
just watch out for that in terms of rubbing around the insertion as well.
I hope that has given you a vague idea of what you should do when you're looking for trainers
after having had an Achilles problem. But it is all about comfort as well
and what you enjoy running in. And if you have any problems, then it is much better
to get someone to look at it and give you a proper plan to getting you back on the road.