Running Shoes for People with Achilles Tendinopathy
(Shoes with a Higher Heel Drop and Rocker Geometry)
In 2024, I completed a PhD with my dissertation focused on Achilles tendinopathy in masters runners. The reasons for this topic choice was that there was little to no evidence on the topic, Achilles tendinopathy is incredibly common among younger athletes and is the most common injury among masters athletes, and I have also struggled with this injury a few times. This is a challenging pathology given its underlying frequency, the time and effort that it takes to heal and how much it impacts running. As the Achilles tendon is an important part of the plantarflexor complex, it greatly impacts one of the most important muscular groups that support and propels the body during running gait. Those who have experienced this pathology know how frustrating it is and how long it can take to heal. The positive news is that with tendinopathies, many people can continue running (and often do) while dealing with it and often find some relief with higher drop, rockered shoes (including myself). To further assist with this, we have put together a guide on shoes that may help those struggling with injuries or problems related to Achilles tendinopathy.
Written By Chief Editor Matt Klein
Edited by Content Manager Bach Pham
What is the Achilles Tendon?
The Achilles tendon is part of the calf complex that connects the gastrocnemius and soleus muscles to the calcaneus (heel) bone. It is a thick band on connective tissue that functions to transmit forces absorbed or generated between the calf complex and foot. While not a contractile tissue the way muscles are, tendons are unique structures that function like living rubber bands. The more elastic they are, the more efficient at transmitting forces they are (to an extent). They are incredibly important during a variety of activities, particularly running. Even during sprinting, there is evidence that the tendons are actually what change length during dynamic activities while muscles contract mostly isometrically (no change in length). This means their ability to extend, retract, absorb and release forces are incredibly important for a variety of dynamic activities. While age and disuse can reduce the tensile integrity and elasticity, pathology of the tendon can also impair its function.
About Achilles Tendinopathies
Achilles tendinopathy, also called tendinosis, refers to a chronic irritation or degeneration of the Achilles tendon. Achilles tendinopathy is one of the most common types of tendinopathies. It is a common pathology in distance runners and the most common injury experienced by masters runners. Unfortunately, Achilles tendinopathy occurs in 50% of runners even without symptoms and it is characterized by its chronic ongoing nature (Lieberthal et al., 2019). This differentiates it from tendinitis, which is the acute inflammatory version that happens less commonly due to the underlying chronicity and prevalence in most tendons. Despite extensive research, there is a limited understanding of the specific causes of this injury, although exceeding load tolerance over time seems to be a potential risk factor (Van der Vlist et al., 2019). This is along other risk factors including the use of certain antibiotics (fluoroquinolones, which are rare now), alcohol use, decreased calf strength, inadequate forward propulsion during gait and decreased lower extremity strength (Van der Vlist et al,. 2019).
It classically presents with pain either where the Achilles inserts into the heel bone (insertional tendinopathy) or behind the ankle in the denser part of the tendon (mid-portion). While there are more pathological variations, these are the most common presentations. Symptoms often include pain with loading or stretching the tendon, especially in the morning or beginning activity. When not severely irritated, it will often "warm-up" and symptoms will decrease during activity, but then may flare up after. Research and clinical experience have shown that staying active during Achilles tendinopathy is safe, although certain modifications may be needed to reduce irritability.
References
Lieberthal, K., Paterson, K. L., Cook, J., Kiss, Z., Girdwood, M., & Bradshaw, E. J. (2019). Prevalence and factors associated with asymptomatic Achilles tendon pathology in male distance runners. Physical Therapy in Sport, 39, 64-68.
Van der Vlist, A. C., Breda, S. J., Oei, E. H., Verhaar, J. A., & de Vos, R. J. (2019). Clinical risk factors for Achilles tendinopathy: a systematic review. British Journal of Sports Medicine, 53(21), 1352-1361.
Lieberthal, K., Paterson, K. L., Cook, J., Kiss, Z., Girdwood, M., & Bradshaw, E. J. (2019). Prevalence and factors associated with asymptomatic Achilles tendon pathology in male distance runners. Physical Therapy in Sport, 39, 64-68.
Van der Vlist, A. C., Breda, S. J., Oei, E. H., Verhaar, J. A., & de Vos, R. J. (2019). Clinical risk factors for Achilles tendinopathy: a systematic review. British Journal of Sports Medicine, 53(21), 1352-1361.
Achilles Tendinopathy, Heel Drop and Rockers
Given the sensitivity to stretch and load, some footwear components may reduce stress on an irritated tendionpathy and facilitate motion to allow activity. The most common methods to reduce stress include a higher heel drop and a rockered sole. Heel drop refers to the difference in height between the forefoot and heel (front and back of your foot/shoe). A higher heel drop reduces the amount of dorsiflexion your foot has to go through, thereby reducing the amount of stretch your Achilles tendon and calf muscles experience during forward gait. A rockered shoe refers to one that has a curved shape that replaces the natural rockers of the foot and ankle (heel, ankle and forefoot rockers). These natural mechanisms allow for efficient gait, although may be impaired due to losses of range of motion or function in those areas. The ankle and forefoot rockers are most important for the Achilles tendon, and a curved sole in the front of the shoe is often most helpful to reduce stress there.
Rockered shoes are known to reduce stress at the Achilles tendon and move it to the hip and knee, so those with concurrent hip/knee pathology should be careful. These rockers can be offset by overly stiff shoes (plated) or ones where the apex of the plate does not match with your biomechanics, so care should be taken in assuming that every rockered shoe will work for you. You must try them on and feel a smooth transition prior to assuming this. An extra note, while the evidence on stability and Achilles tendinopathy has weakened recently, it is far better to have a more stable shoe than unstable one for this pathology.
Rockered shoes are known to reduce stress at the Achilles tendon and move it to the hip and knee, so those with concurrent hip/knee pathology should be careful. These rockers can be offset by overly stiff shoes (plated) or ones where the apex of the plate does not match with your biomechanics, so care should be taken in assuming that every rockered shoe will work for you. You must try them on and feel a smooth transition prior to assuming this. An extra note, while the evidence on stability and Achilles tendinopathy has weakened recently, it is far better to have a more stable shoe than unstable one for this pathology.
Running Shoes with High Heel Drops and Rockered Soles
(Click to Learn More About Each Shoe)
(Click to Learn More About Each Shoe)
Shoes for People With Achilles Tendinopathy
-- Higher Heel Drops and Rockered Soles --
-- Higher Heel Drops and Rockered Soles --
(While there are not many high heel drop shoes left, most shoes do have some kind of rocker with their taller stack heights. Specific shoes will work better than others)
Neutral Trainers (that are mostly stable)
Asics Nimbus 27
(A tall but stable shoe with a large forefoot rocker due to its stack height)
Brooks Ghost 17
(Although lower than previous years, the higher drop, now stable neutral trainer may work if the snug heel doesn't bother you)
Neutral Trainers (that are mostly stable)
Asics Nimbus 27
(A tall but stable shoe with a large forefoot rocker due to its stack height)
Brooks Ghost 17
(Although lower than previous years, the higher drop, now stable neutral trainer may work if the snug heel doesn't bother you)
Mizuno Neo Vista 2
(A moderate drop, bouncy shoe offloads the Achilles. The lack of a heel counter is great for those with sensitivity at the insertion.
(A moderate drop, bouncy shoe offloads the Achilles. The lack of a heel counter is great for those with sensitivity at the insertion.
Nike Vomero Plus
(A large heel drop, rockered ride and bouncy ride may offload the Achilles)
Nike Vomero Premium (review soon)
(a higher heel drop, bouncy shoe with a large rocker may totally offload the Achilles)
Puma MagMax
(A maximal stack height shoe with a moderate drop and large forefoot rocker)
Stability Trainers
ASICS Gel-Kayano 32
(A moderate drop stability shoe with a padded heel and good forefoot rocker)
Brooks Glycerin GTS 22
(A higher heel drop, stability shoe. Its non-stability counterpart may also work)
Mizuno Wave Inspire 21
(A classic, high drop, stability shoe)
(A large heel drop, rockered ride and bouncy ride may offload the Achilles)
Nike Vomero Premium (review soon)
(a higher heel drop, bouncy shoe with a large rocker may totally offload the Achilles)
Puma MagMax
(A maximal stack height shoe with a moderate drop and large forefoot rocker)
Stability Trainers
ASICS Gel-Kayano 32
(A moderate drop stability shoe with a padded heel and good forefoot rocker)
Brooks Glycerin GTS 22
(A higher heel drop, stability shoe. Its non-stability counterpart may also work)
Mizuno Wave Inspire 21
(A classic, high drop, stability shoe)
Puma ForeverRun Nitro 2
(A centrally guided, well-cushioned, higher drop shoe with a forefoot rocker)
Performance Trainers
ASICS Megablast
(A popular shoe, the rocker profile, moderate drop and bouncy midsole may offload at faster paces)
Mount to Coast P1
(A higher heel drop, ultramarathon stability racing shoe)
(A centrally guided, well-cushioned, higher drop shoe with a forefoot rocker)
Performance Trainers
ASICS Megablast
(A popular shoe, the rocker profile, moderate drop and bouncy midsole may offload at faster paces)
Mount to Coast P1
(A higher heel drop, ultramarathon stability racing shoe)
(A moderate drop with a large forefoot rocker may reduce stress. Watch out for the stiff counter)
Racing Shoes
Saucony Endorphin Pro 4
(A moderate drop with a stable neutral platform and excellent forefoot rocker)
Have questions? Send us an email at doctorsofrunning@gmail.com
Thanks for reading!
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