What is Achilles Tendinitis? Symptoms, Causes, & Treatment

Achilles tendinitis is inflammation of the thick band of tissue that connects your calf muscles to your heel bone. This condition causes pain and stiffness along the back of your ankle, especially when you first wake up or after periods of rest.

Your Achilles tendon works incredibly hard every day, helping you walk, run, jump, and push off your toes. When it becomes overworked or strained, tiny tears can develop in the tissue, leading to inflammation and discomfort that can make even simple activities challenging.

What are the symptoms of Achilles tendinitis?

The most common sign is a dull ache or pain along the back of your leg or above your heel. This discomfort typically starts mild but can gradually worsen if left untreated.

Here are the key symptoms you might experience, and it's completely normal to have some or all of these:

• Morning stiffness that improves as you move around
• Pain that worsens after exercise or activity
• Tenderness when you touch the tendon
• Swelling along the tendon or at the heel
• A crackling or creaking sound when you move your ankle
• Thickening of the tendon that you can feel
• Difficulty pointing your toes or pushing off during walking

In rare cases, you might experience severe, sudden pain if the tendon partially tears. This usually happens during intense activity and feels like someone kicked you in the back of the leg. While uncommon, this requires immediate medical attention.

What are the types of Achilles tendinitis?

There are two main types, and knowing which one you have helps guide the best treatment approach. The location of your pain tells the story.

Non-insertional Achilles tendinitis affects the middle portion of the tendon. This type is more common in younger, active people and typically develops from overuse during sports or sudden increases in activity levels.

Insertional Achilles tendinitis occurs where the tendon attaches to your heel bone. This form often affects people of all activity levels and can develop alongside bone spurs. It tends to be more stubborn to treat because the area has limited blood flow.

What causes Achilles tendinitis?

Most cases develop gradually from repetitive stress on the tendon over time. Your Achilles tendon can handle a lot, but when demands exceed its capacity to recover, problems begin.

The most common reasons this happens include:

• Sudden increases in exercise intensity or duration
• Tight calf muscles that put extra strain on the tendon
• Running on hills or uneven surfaces regularly
• Wearing worn-out or inappropriate shoes
• Having flat feet or high arches
• Age-related changes that make tendons less flexible

Less commonly, certain medications can weaken tendons. Fluoroquinolone antibiotics, though helpful for infections, can rarely make tendons more prone to injury. Additionally, people with conditions like rheumatoid arthritis or psoriasis may have higher risk due to systemic inflammation.

When to see a doctor for Achilles tendinitis?

You should contact a healthcare provider if your heel pain persists for more than a few days or interferes with your daily activities. Early treatment often leads to better outcomes and faster recovery.

Seek immediate medical care if you experience sudden, severe pain in your heel or calf, especially if you heard a "pop" sound. This could indicate a tendon rupture, which requires prompt treatment to prevent complications.

Also schedule an appointment if you notice significant swelling, cannot bear weight on your foot, or if your symptoms worsen despite rest and home care measures.

What are the risk factors for Achilles tendinitis?

Several factors can make you more likely to develop this condition, though having risk factors doesn't mean you'll definitely get tendinitis. Understanding these can help you take preventive steps.

Physical factors that increase your risk include:

• Being between 30-50 years old when tendons naturally become less flexible
• Having tight or weak calf muscles
• Foot structure issues like flat feet or high arches
• Previous ankle or heel injuries
• Leg length differences that affect your gait

Activity-related risks involve sudden changes in your routine or training errors. Weekend warriors who are sedentary during the week but very active on weekends face higher risk.

Certain medical conditions can also contribute. Diabetes, high blood pressure, and autoimmune conditions like rheumatoid arthritis can affect tendon health. Some medications, particularly certain antibiotics and corticosteroids, may also increase vulnerability.

What are the possible complications of Achilles tendinitis?

Most people recover completely with proper treatment, but ignoring symptoms can lead to more serious problems. The good news is that complications are preventable with appropriate care.

Chronic tendinitis can develop if acute symptoms aren't addressed. This creates ongoing pain and stiffness that becomes much harder to treat. The tendon may thicken and develop scar tissue, making it less flexible and more prone to future problems.

In rare cases, untreated tendinitis can progress to tendon rupture. This happens when the weakened tendon finally gives way, usually during sudden movement or activity. While uncommon, ruptures often require surgical repair and lengthy recovery.

Some people develop insertional tendinitis with bone spurs, which are bony growths where the tendon meets the heel bone. These can cause persistent pain and may need specialized treatment approaches.

How can Achilles tendinitis be prevented?

Prevention focuses on keeping your Achilles tendon strong, flexible, and not overworked. Simple daily habits can significantly reduce your risk of developing problems.

Start any new exercise program gradually. Your tendons need time to adapt to increased demands, so increase your activity level by no more than 10% each week. This gives your body time to strengthen without breaking down.

Keep your calf muscles flexible through regular stretching. Tight calves put extra stress on your Achilles tendon, so gentle stretching before and after activity helps maintain healthy length and flexibility.

Choose appropriate footwear for your activities. Replace worn-out shoes before they lose their support, and consider shoes designed for your specific foot type if you have flat feet or high arches.

Cross-training helps prevent overuse by varying the stress on your tendons. Mix activities like swimming, cycling, or strength training with your regular routine to give your Achilles tendon breaks from repetitive stress.

How is Achilles tendinitis diagnosed?

Your doctor will start with a physical examination and discussion of your symptoms and activities. This conversation helps identify what might have triggered your condition and guides the examination.

During the physical exam, your doctor will gently feel along your tendon to locate areas of pain, swelling, or thickening. They'll also test your ankle's range of motion and strength to understand how the condition affects your function.

Imaging tests aren't always necessary but can provide helpful information in certain cases. Ultrasound can show tendon thickness and detect tears, while MRI gives detailed pictures of the tendon and surrounding tissues.

X-rays might be ordered to check for bone spurs or calcium deposits, especially if you have insertional tendinitis. These tests help your doctor understand the full picture and plan the most effective treatment.

What is the treatment for Achilles tendinitis?

Treatment focuses on reducing pain and inflammation while helping your tendon heal properly. Most people improve significantly with conservative treatments that you can start at home.

Rest is the foundation of treatment, but this doesn't mean complete inactivity. You'll need to avoid activities that worsen your pain while maintaining gentle movement to prevent stiffness. Swimming or upper body exercises can help you stay active without stressing your tendon.

Ice therapy helps control pain and swelling, especially in the first few days. Apply ice for 15-20 minutes several times daily, but always protect your skin with a thin towel or cloth.

Physical therapy plays a crucial role in recovery. A physical therapist will teach you specific exercises to stretch tight muscles and strengthen weak ones. Eccentric exercises, where you slowly lower your heel while your calf muscles lengthen, are particularly helpful for tendon healing.

Your doctor might recommend anti-inflammatory medications to help with pain and swelling. These work best when combined with other treatments rather than used alone.

For persistent cases, additional treatments might include corticosteroid injections, though these are used cautiously around tendons. Newer treatments like platelet-rich plasma (PRP) injections show promise for chronic cases, though more research is ongoing.

How to manage Achilles tendinitis at home?

Home treatment forms the backbone of recovery for most people with Achilles tendinitis. These strategies can significantly speed your healing when done consistently and correctly.

The RICE method provides an excellent starting point. Rest means avoiding activities that increase your pain, though gentle movement is still important. Ice helps with acute pain and swelling. Compression with an elastic bandage can provide support, and elevation helps reduce swelling when you're resting.

Gentle stretching becomes increasingly important as your pain improves. Calf stretches against a wall or using a towel while sitting can help maintain flexibility. Start gently and gradually increase the stretch as tolerated.

Consider heel lifts or supportive shoes to reduce stress on your tendon during daily activities. A small heel lift in both shoes can decrease the pull on your Achilles tendon while it heals.

Pay attention to your body's signals. Some discomfort during gentle activity is normal, but sharp or increasing pain means you should back off and rest more.

How should you prepare for your doctor appointment?

Being prepared helps your doctor understand your condition better and develop the most effective treatment plan. A little preparation can make your visit much more productive.

Write down your symptoms, including when they started, what makes them better or worse, and how they affect your daily activities. Note any recent changes in your exercise routine or activities that might have triggered the problem.

Bring a list of all medications and supplements you're taking. Some medications can affect tendon health, so this information helps your doctor understand the complete picture.

Prepare questions about your condition. You might want to ask about expected recovery time, which activities are safe to continue, and warning signs that might indicate complications.

Consider bringing the shoes you wear most often, especially athletic shoes. Your doctor can assess whether your footwear might be contributing to your problem.

What's the key takeaway about Achilles tendinitis?

Achilles tendinitis is a common, treatable condition that responds well to early intervention and consistent care. While it can be frustrating and painful, most people recover completely with appropriate treatment.

The key to successful recovery lies in addressing the condition early, following through with treatment recommendations, and gradually returning to activities. Patience during the healing process helps prevent setbacks and ensures long-term success.

Remember that healing takes time, and everyone's recovery timeline is different. With proper care and attention, you can expect to return to your normal activities and reduce your risk of future problems.