Ask Sock Doc: Achilles Tendon Issues, Ditch the Orthotics, and Harmful Side-effects of Nonsteroidal Anti-inflammatory Drugs

P1070534Q: I switched to minimalist shoes some time ago, and in the beginning they really helped. Recovery time after long runs shortened, and constant issues I had with my IT band simply disappeared. Unfortunately something has gone badly wrong lately,and for whatever reason I’m getting constant problems with my Achilles tendon. I did a lot of reading about natural running, watched several videos about it, tried to follow their approach, but the issues with my tendons are always present, to the point I may give up running. I recently saw a sports doctor because of this problem, and he told me all this “natural running thing” is just a fad, that the heel was designed to absorb impacts, and since I overpronate, I should be buying structured shoes to help correct the problem. I am really confused.What should I do?

SD: The heel absorbs impact? That’s news to me. Actually it’s proper pronation of the foot and natural and essential lengthening of the Achilles which deal with much of the impact force. When a person’s body is used to wearing traditional shoes with an elevated heel for so long, their Achilles tendon shortens. If that person switches to a minimalist-type shoe faster than their body can adapt (and their Achilles can lengthen), then a problem in the tendon can result. There are two things you can do to help this problem you’re having. One is to try just a bit more shoe to see if that lessens some of the Achilles tendon pain. So if you’re in a zero-drop shoe, try a 4mm drop. If you’re in a 4mm drop, try a 6-7mm for a bit, but only if it helps while the tendon heals. The other thing you can do is look for trigger points to massage out with deep pressure in the calf muscles, especially lower in the calf (soleus) just above where the Achilles tendon starts and 2-4″ higher up in the lower leg. Stay off the Achilles tendon and look for points in the calves instead, massaging any sore spots out for 30 or so seconds. You might also find compression socks to benefit you as you heal up – making it three things you can try!


Q: I currently wear arch orthotics in my running shoes. But after reading some of the articles on this website, I now want to switch out of the orthotics and transition from a elevated-heel running shoe to a transition shoe. Should I switch out of the orthotics first and transition to the transition shoe later or switch from the elevated heel with orthotics to the transition shoe without orthotics completely? Either way, should I still transition 10% mileage per run? Or is this too difficult to recommend without seeing the condition of my feet?

SD: The transitional phase is different for each individual. Typically in my office I have my patients get rid of their orthotics immediately so their foot is no longer in a dysfunctional-supported state. I’ll have them remain in their same shoes for some time during this period unless the footwear they are currently wearing is hindering their movement (think women’s high heals or very thick and stiff shoes for both men and women). During this transitional period I have my patients walk and move barefoot in their house and at work as much as they comfortably can. Once they’re able to remain barefoot without any problems for an extended period of time, I’ll have them move into a transitional shoe. The only exception to this is if the current footwear is limiting their ability to go barefoot more often. I always recommend moving to less shoe as quickly and as comfortably as possible. Since this is different for everyone, I personally don’t use the 10% rule as some can progress much faster, and some much slower, than any set number.


Q:Is there a long-term risk in taking either Advil or Tylenol on a regular basis? It just seems that whenever I up my weekly mileage to include runs over 10 or12 miles, I get a sharp pain just below my left knee. So I pop a pill  or two when I get home.  The next morning, most of the pain has seemingly vanished, though the area still feels stiff and not quite right. But after two days of rest, except for some walking of a few miles, my leg feels fine. I want to do an ultra some day. Please advise, Sock Doc!

SD: Absolutely there is a long-term risk particularly with NSAIDs (nonsteroidal anti-inflammatory drugs such as aspirin, naproxen, and ibuprofen). Some of the risks include gastrointestinal, (they have found fecal bacterial in the blood of ultra-marathoners taking NSAIDs), cardiovascular, musculoskeletal, and renal (kidney) side-effects and complications. NSAIDs require sulfur  to be properly detoxified by the liver. Sulfur is needed to make glucosamine sulfate and chondroitin sulfate which helps facilitate cartilage repair. The amino acid L-cysteine is very high in sulfur and can sometimes be of great benefit as a supplement, and it’s also high in protein-rich foods like eggs and whey protein.  Sulfates are high in foods such as broccoli, cauliflower, garlic, cabbage, onions, radishes, and mustard. Proper levels of magnesium, vitamin B12, vitamin B6, (in its active form of pyrodixal-5-phosphate), and folic acid, (also typically in its active form of 5-MTHF), are also needed for proper sulfation.

If you’re having a knee problem you very well may be creating more problems in that joint (and others) the longer you take these meds. Sulfation is also how you detoxify cortisol, a common stress hormone that your body makes to help balance your blood sugar and deal with inflammation. I always tell my patients that if you ever feel better from taking any anti-inflammatory then it’s a sure sign that you’re suffering from an inflammatory condition, otherwise you’d see no effect taking the drug. So look to your diet, lifestyle, and training as sources of too much stress and inflammation because if you keep on the path you’re on now,  it’s only a matter of time before you become seriously injured and can’t run at all.


Sock Doc is Dr. Steve Gangemi. His site is a great resource for injury treatment and prevention.

9 Responses to “Ask Sock Doc: Achilles Tendon Issues, Ditch the Orthotics, and Harmful Side-effects of Nonsteroidal Anti-inflammatory Drugs”

  1. Pepijn says:

    Nice article, great warning!

    I’ve coached a view runners last year with the transition from normal running to barefootstyle running. One of them is running 15 min barefootstyle now. But it toke over 7 months to get there. An other one is running 10 Miles right now and is just 2 months a barefootstyle runner.

    The whole transition depends on the health / condition and adaptation of the body. The are now rules… There is one: “listen to your body”! And please do not take medication or anything els.

    Regards, Pepijn

  2. Nick says:

    James Dunne on Kinetic Revolution also suggest that weak or inactive glutes can cause one to compensate by driving more with the foot than they should, causing achilles pain.

  3. Jim H says:

    re: Achilles issue. I had the same problem, even after 3+ years and 40+ road & trail races exclusively barefoot & minimalist. Trigger Point Therapy is absolutely spot on, worked miracles for me. I used a foam roller, the Stick, and a lacrosse ball at various points (pun intended) for self myofascial release. (Those are terms you can Google for help)

    Also, eccentric heel drops proved a big aid in the AT lengthening process.

    (btw: webmaster: your CAPTCHA Code is nearly impossible to read and work. it makes commenting here ridiculously hard.)

  4. Sock Doc says:

    Nick – agree with the glutes, good point. I see that a lot.

    Jim – I never use eccentric heel drops. I think they’re relatively worthless – it’s very little weight (your body weight minus some of your leg) and not enough in my opinion to create an eccentric weighted load. So it’s stretching. Walking/running barefoot and jumping much more effective.
    Though I agree on the CAPTCHA Code – what the heck!

  5. janna says:

    I had the exact same issue and just happened to read another article that recommended the same thing. I switched from my barefoot shoes to minimalist & it cleared the issue right up. Now I’m adding walking with my barefoot shoes to help strengthen my feet (spending as much time in them as possible) & hope to work up to being able to use my barefoot shoes again. But if not – well – I’m still in a great spot being able to run once again.

    Listen to your body is the def. the best advice.

  6. Jeromey says:

    After recovering from an IT-band injury when training for a marathon in “regular” shoes, I moved to Vibram 5-fingers over a year ago. (I figured since I’d need to transition slowly back into running post-injury anyway, it was a good time to try the minimalist approach.)

    I always had challenges with my achilles, particularly on my left leg, and have not gone back to long runs as a result.

    For 3 months, though, I’ve now suffered massive pain in the left heel to the point I can’t run at all any longer. (Interestingly, the pain moves from directly under the heel to the side of the heel).

    I’ve self-diagnosed as planter’s (though no pain in the arch), and physio recommends buying arch supports and keeping off the barefoots at least until I’ve recovered.

    Feeling a little confused by conflicting advice…Any help? (I’ve had to take up biking since I literally cannot run.)

    • Sock Doc says:

      Check out the Sock Doc Plantar Fasciitis video on the website, as well as the Achilles Tendonitis Video. You most likely are dealing with either a soleus and/or a tibialis posterior problem. Arch supports might make you feel better (reduce pain) but they won’t strengthen your arch or feet.

  7. Bob says:

    9 months ago I had partial knee replacement surgery at age 63. I started running within a month, using minimalist shoes, avoiding the heel strike in order to minimize shock to the knee. I felt great the first few times, running 2 miles. But by the 3rd time my calf was killing me, and I couldn’t even run 2 blocks. I stopped running for several weeks, but still had calf pain when I tried to run again. I stopped running again for a month, but again had pain. It’s now been 7 months since I injuried my calf and I still can’t run, even with regular thick soled Hoka shoes. I’m getting really discouraged, since the main reason I had the knee surgery was to run again. I’m very excited about the barefoot running method, and I know I should have started much slower, but I wonder if it’s too much strain on 63 year old calves. Any suggestions to properly heal so I can run again?

  8. Jake Harry says:

    Thanks for the post.

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