Why achilles pain and heel pain can occur in minimalist running shoes [PAIN TREATMENT] (2024)

When training hard sometimes I hit a ‘bump on the road’, especially if I run too much in a softer shoe or do too many consecutive fast sessions on grass. For me it’s usually a very stubborn and tight calf (running steep downhills) or tight peroneal muscles on the side of my lower leg (landing slightly on the outside of my foot). As a Neuromuscular Physical Therapist I can usually sort the problem out myself, but sometimes it can be stubborn so I go to my own therapist for an ‘intervention’. Then I make sure I don’t let it happen again and I learn from my mistake…well I try to!

This question was asked by someone transitioning to minimalist running:
“I’ve been dealing with heel pain (both feet) since December, which is diagnosed by my orthopedic as Achilles tendonitis. I’m doing a lot of things: toega, eccentric calf raises, working on increasing hip mobility, etc. Not much progress yet (my fault definitely cause I’m not too consistent). I’ve literally stopped all activities such as running or hiking, which is killing me. My only activities are walking the dog, cycling to work and few bodyweight exercise session a week. Last week orthopedic gave me custom made shoe insoles. I have told him that I’m walking barefoot or in barefoot shoes (Vivobarefoot and FiveFingers) but he was insisting. So my question is – go with the insoles or not? I don’t see the purpose of having them temporary as some kind of quick fix (if that’s even gonna happen) and I definitely don’t want them long term..”

ARE YOU RUNNING LIKE A DONKEY OR JUST MISSING A PILLAR?

When you TRANSITION to minimalist running you generally transfer all the injury risk you experienced as a jogger (aka heel striker) from the knee upwards to anywhere below the knee. Tight calves / sore achilles / stress fractures in metatarsals are all quite common for a lot of people who transition to minimalist running incorrectly, and it’s the number one reason why a lot of physios, coaches and running shoes sales people will tell you to stay a million miles from barefoot running and minimalist shoes. But you know what? Sometimes they have a point, even if they don’t know why they’re right!

You see, you may change your footwear to be more minimalist but if you still run like a donkey you’re still going to get injured! And even if you do learn how to run with good technique and one of the three pillars of good running technique is missing, either ‘posture’, ‘rhythm’ or ‘relaxation’, even for a few runs, you are also going to hit a ‘bump on the road’ and your body will let you know about it by giving you pain or an injury!

BUT WHY DOES HEEL / ACHILLES PAIN OCCUR?

To run in minimalist footwear you have to land on a relaxed foot and calf muscles. But if you’ve always been in cushioned shoes running before that, how long could you stay relaxed do you think? Probably not long, or maybe not at all! If you tense your feet/calves (consciously or subconsciously) and land on a hard surface (remember no more cushioning) they won’t be very happy after a while and they will develop TriggerPoints and calf and foot muscles will tighten up.

“I have a problem with my heel and achilles, why are you talking about feet and calves???”

Well during your run or the next day you may feel pain in your calves, achilles and / or heel! Runners transitioning to minimalist usually experience some sort of pain somewhere in the lower leg when they land on a tense foot/calf instead of a relaxed foot/calf. In this particular case heel and achilles pain is usually a result of tight muscles in the calf and the arch of the foot.

When such a ‘bump on the road’ occurs, a patient and determined runner making the transition will write it off as ‘too much, too soon’, do some soft tissue release work themselves, go back to their drills and start again a bit more conservatively. If you struggle to get the three pillars of good running technique correct (‘posture’, ‘rhythm’ and ‘RELAXATION‘ in this case!) the ‘quality running and drills‘ approach is required (e.g 2min easy run, 3 min relaxation drills for 60mins etc.) so you can slowly transition over time (58mins easy run, 2min drills etc). When you overdo it or get it wrong you can experience such a ‘bump on the road’ and may find yourself in the chronic injury cycle where muscles are forever tense and they never relax…BUT

HOW DO YOU RELIEVE THE PAIN NOW!?

Well that’s the easy bit! Just because the achilles or heel is sore, it doesn’t mean that it’s the culprit…it’s the victim in this case. The approach I use here in JK Therapy is to clear out TriggerPoints (TrP’s) (think of them as knots if you wish) in the calf and the arch of the foot which you can see illustrated in the picture. These TrP’s are the culprits! The areas marked with an X in the picture ‘refer‘ pain to the red shaded areas.

The sneaky thing about TrP’s is that they can be responsible for pain in areas quite a distance from where they are usually found, i.e. the calf and heel are a good way off from one another! We call this TrP pain referral. So a good ‘clear out’ of the calves using myofascial release techniques will certainly relieve the pain. Ultrasound therapy will also help break down any scar tissue and indeed settle the achilles tendon itself if it’s sensitive to the pinch test. Unfortunately you can’t exercise or strengthen your way out of this problem, there is no point strengthening a dysfunctional muscle full of trigger points using heel raises or heel drops, this will just create more trigger points…BUT

WHY IS THE PAIN OCCURING IN THE FIRST PLACE?

This is the real question for transitioning runners and you should have realised why it’s happening from reading above! In my experience as a running technique coach and Neuromuscular Physical Therapist it’s due to too much tension in the foot and calf when you land on it.

A number of things which may be going wrong include:

1. Still landing on their heel without realising it, yes even in minimalist shoes!
2. Never letting the heel fully touch the ground aka ‘princess running’! This is like doing thousands ofeccentric heel drops during your run, your calf is wrecked from the effort!
3. Bracing the foot and calf before landing on it (consciously or subconsciously)
4. Pushing off the foot using the calf which creates excessive vertical oscillation (too much bouncing), this is like doing thousands of heel raises!

These problems need to be coached or trained out of the runner to stop the calf getting tight in the future…otherwise any sort of physical therapy is just like popping a pain killer, it will likely come back again the next time. “Ka-ching!” goes your therapist!

So a plan of action rather than going into orthotics:

1. Relieve the pain by clearing out the TriggerPoints, break down scar tissue and increase blood flow to heal the tissue in the calves and arch
2. Learn from your therapist how to do soft tissue release work yourself, it’s not hard once you know how!
3. Coach out the harmful movement (landing on a tense foot/calve) you are putting into the body by doing running relaxation drills
4. Most importantly, with every injury or problem you have keep asking yourself and your therapist the question “but why…?“.

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