Zero-drop shoes and Achilles tendonitis - your questions answered

In this article, we answer the two questions we get asked most often about zero-drop shoes: whether they might be the cause of your Achilles pain and whether you should wear them while you're recovering from Achilles tendonitis. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in our articles.

In this article:

1. Do zero-drop shoes cause Achilles tendonitis?

2. Are zero-drop shoes good for Achilles tendonitis?

3. So, are zero-drop shoes generally bad for the Achilles tendon?

4. How we can help

We also made a video about this:

Do zero-drop shoes cause Achilles tendonitis?

Yes, zero-drop shoes can cause Achilles tendonitis when they are used incorrectly. But just because you're wearing them, does not mean that they are definitely to blame for your pain. Let's look at two scenarios we often see in runners; the same principles apply to walkers.

Runner 1: First time running in zero-drop shoes

If you’ve recently decided that you want to change from running (or walking) in a regular shoe (with a bit of a raised heel) to flatter or zero-drop shoes, then the likely cause of your Achilles tendonitis is that you’ve made the transition too quickly.

Placing the foot in a flatter shoe means that the Achilles tendon now has to work in a more lengthened position than before. It was very happy and strong when working in the previous range, where the heel was slightly lifted, as it has had years to get used to it. But now you’re asking it to work through an extra bit of range, where it has not worked much before and for which it lacks the necessary strength and endurance.

The Achilles tendon requires time to grow strong in that position. To make a safe transition, you usually have to do a lot of strength training, e.g. by doing heel raises over the side of a step, and start with only extremely short walks or runs in the zero-drop shoes. A safe transition should take at least 12 weeks, but often longer; it depends on your age and your training volume.

This is why it is so easy to injure your Achilles tendon when you move from running in regular shoes to zero-drop shoes. Many people just don’t appreciate how much time the Achilles tendons need to build the strength and endurance required to cope with their normal running loads in that new, more lengthened position.

Runner 2: Has been running in zero-drop shoes for years without problems ... until now

If you’ve been running in zero-drop shoes for a long time, it is very likely that your shoes are not to blame for your Achilles pain. Your Achilles tendons should be 100% used to them and strong enough to function normally in them.

It is much more likely that your Achilles tendonitis has been caused by a training error, e.g. too much high-intensity training without enough recovery time or ramping up your mileage too quickly. Your physio should be able to help you figure out what went wrong.

The only exception is if, for some reason, you’ve not been wearing flat shoes for the last 6 to 12 weeks, and then suddenly went back to wearing them. If that’s the case, they might have played some part in causing your injury, same as with Runner 1.

Are zero-drop shoes good for Achilles tendonitis?

No, it will not make your injured Achilles tendon heal any faster and may even cause it to be more painful, especially if you’ve not worn zero-drop shoes before.

When you have Achilles tendonitis, the tendon becomes very sensitive to being stretched. When you wear a zero-drop shoe, it is easier for your foot to go into positions that stretch and irritate the tendon.

So, if you want your irritated tendon to calm down and recover more quickly, it is usually better to wear a shoe that lifts the heel up a bit or even to place heel lifts in your shoes, taking the strain off the tendon.

Does this mean that you should never wear zero-drop shoes again?

No. Once your Achilles pain has calmed down and your rehab has progressed to the point where your tendon is happy with being lengthened and stretched, you can transition back to them. Your physiotherapist can help you decide when is the best time for this.

So, are zero-drop shoes generally bad for the Achilles?

Zero-drop shoes as such are not bad for the Achilles tendon; it's about how you use them. Like we’ve mentioned earlier, these shoes can cause Achilles pain when you transition to them too quickly from using shoes with a bit of a raised heel, and the tendon has to work in a range where it has never had to before.

If you do specific strength training exercises that ensure that the Achilles builds strength in the new range that you’re asking it to work in (where it is in a more lengthened position) and you make the transition really slowly (little bits per training day and not increasing too quickly), you should not have any problems. Like we’ve mentioned before, making a safe switch could take at least 12 weeks, but often longer.

How we can help

Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master's Degree in Sports Injury Management. Follow her on LinkedIn or ResearchGate.