Chronic Achilles tendonitis may be caused by several factors. According to the Mayo Clinic website, Achilles tendonitis or inflammation of the Achilles tendon is a common sports injury, especially among runners. The Achilles tendon is a thick band of tissue that links the calf muscles to the calcaneus, or heel bone. Achilles tendon injuries can be debilitating and limit a person's ability to perform his usual activities of daily living.
Inappropriate Footwear
Inappropriate footwear can cause chronic Achilles tendonitis. According to Daniel Howell, Ph.D., a professor of anatomy and physiology at Liberty University and the author of "The Barefoot Book," conventional footwear reduces the length, strength and power of the Achilles tendon calf muscles and causes Achilles pain when standing without shoes. Dr. Ray McClanahan, a Portland, OR-based sports podiatrist, states that Achilles tendonitis occurs frequently in runners who train in conventional running shoes, which possess elevated heels, tapering toe boxes and toe spring, and then race in a racing flat or spike that has little or no heel elevation. The elevated heels built into conventional running shoes cause the Achilles tendon to shorten, as Howell notes, and force the Achilles tendon to stretch up to an inch more than when racing in racing flats. McClanahan recommends wearing shoes that are flat, widest in the toe box and flexible in the sole to help avoid chronic Achilles tendonitis.
Training Alterations
Training alterations are a common cause of Achilles tendonitis. McClanahan states that training alterations among runners, such as increasing mileage before the tendon can develop adequate strength and flexibility, can lead to Achilles tendonitis. According to the Sports Injury Clinic website, the sudden introduction of hill running into a runner's training program can also place a significant amount of stress on the Achilles tendon, as the tendon has to stretch more than usual with each stride. The Sports Injury Clinic website notes that periodically stretching out the Achilles tendon is fine, but consistent hill running by a person whose Achilles tendon has not yet adapted to the new forces placed upon it will cause the tendon to fatigue sooner than normal, and may lead to chronic Achilles tendonitis, especially if the condition remains untreated. A runner should consider introducing hills into his training routine over a longer period of time to avoid Achilles tendon pain and discomfort.
Repetitive Strain
Repetitive strain or overuse injuries are a common cause of Achilles tendonitis. According to the Cleveland Clinic, one of the top four hospitals in the United States, Achilles tendonitis is an inflammation of the tendon and is frequently caused by overuse. The Cleveland Clinic notes that any activity involving a pushing-off, such as basketball or running, can cause Achilles tendonitis, and that if Achilles tendonitis is left untreated, scar tissue will form and gradually replace the healthy parts of the tendon itself. The longer Achilles tendonitis treatment is delayed, the more challenging the condition is to treat. The Cleveland Clinic recommends several treatment methods for chronic Achilles tendonitis caused by overuse including rest, stretching activities, ultrasound, rehabilitation exercises and shock wave therapy. Instrument-assisted soft tissue mobilization, or the use of tools to reduce Achilles tendon scar tissue and pain may also be effective for this condition.
