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Foot Health: Why do my feet feel great in heels, but hurt in flats? Achilles tendonitis may be the answer

By Dr. Nicole Freels
Special to KyForward

Sometimes we hear, “I can wear high heels all day, but my feet hurt in flats.”

What’s happening is that the heels are simultaneously masking the pain because they cause the cord to shorten, but also are exacerbating the issue.

Achilles tendinitis is an overuse injury of the Achilles tendon. This often occurs in runners or other sports enthusiasts who engage in repetitive motion of the legs. It can happen from the sudden shifts in movement in those who play sports like tennis, or it can happen when a runner suddenly increases the intensity or duration of training. It usually begins with a tenderness in the calf or above the heel after exercise. It can become more painful with intense exertion (like hill running), and you might wake up with a stiffness in the back of the leg that improves with movement.

Since most runners can’t imagine being sidelined from their favorite runs (at least not for long!) there are a few things exercisers should know about Achilles tendonitis:

1. There are risk factors:

Men are naturally more susceptible to Achilles tendinitis, and it is more common as we age. Certain physical conditions such as anatomically flat arch, obesity and tight muscles can also put you at risk. Also, training choices like wearing improper or worn out shoes, increasing training intensity without easing into it, and lots of hill runs can cause tendonitis. Certain medical conditions and medications can also cause it.

2. You can prevent it:

It is important to note that Achilles tendinitis is preventable. While we may not be able to control the wear and tear on our bodies as we age (any long-term runner can attest to having at least one issue in their running careers!) or having flat feet, there are other choices that can prevent this condition. First, ease into your training plan. If you want to increase your mileage or intensity, do so slowly. Make sure to warm up properly before hitting it hard. Also, vary your terrain. If you are doing lots of hills, it may be a good idea to throw some flat runs in for variety.

Stretch carefully before and after each run. This seems obvious, but so many runners skip the stretch to get on with their day, not knowing they are setting themselves up for injury. Make sure your shoes fit properly and are not worn out! A professional fitting is worth its weight in gold, because a running specialist can advise the best shoe for your foot and gait. And another very important tip is to cross-train.

Not only will choosing activities that are low impact or use other muscles reduce the pressure on your Achilles tendon, its fun to mix it up and will improve your fitness. Adding weights to your regime, particularly strength training that builds the calf muscles, is also a good tool.

3. Treatment

Your tendinitis may be mild enough to treat at home with rest (try a different activity such as swimming for a few days, or take a break from exercise), ice the leg, use a compression bandage, or elevate the leg. However, if the pain doesn’t subside with home treatments and changing your training practices, you’ll need to see a podiatrist, who may prescribe pain relievers, physical therapy, or surgery, depending on the severity of the condition.

Remember, once you acquire Achilles tendinitis, you are prone to getting it again. It’s very important to do daily stretches to prevent a relapse!


Dr. Nicole G. Freels, FACFAOM, is an associate at Lexington Podiatry

For more Foot Health columns, click here.

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