What is it?
The Achilles tendon connects the calf muscles to the heel bone. Repetitive strain causes changes within the tendon that make it thickened, stiff, and painful. When the problem is in the middle of the tendon it is called mid-portion tendinopathy; when it is where the tendon meets the heel it is called insertional tendinopathy.
What causes it?
- A sudden increase in running, hills, or speed work
- Tight or weak calf muscles
- Worn or low-drop footwear introduced too quickly
- Flat feet or other mechanical factors
- Certain antibiotics (fluoroquinolones) and some medical conditions
What does it feel like?
- Pain and stiffness in the tendon in the morning
- Pain at the start of exercise that may ease, then return after
- A thickened or tender area 2–6 cm above the heel
- Creaking or swelling along the tendon
How is it diagnosed?
An exam of the tendon and calf is usually enough to make the diagnosis. Ultrasound in the office shows tendon thickening and tears. MRI is used when a significant tear is suspected or surgery is being considered.
When should you see a podiatrist?
- A sudden pop or a feeling of being kicked in the back of the leg — this can be a rupture and should be seen promptly
- Pain that has lasted more than two weeks
- A visible lump or swelling on the tendon
- Pain that is stopping you from exercising
Nonsurgical treatment
- Loading exercises
- A progressive calf-strengthening program is the most effective treatment for most people.
- Activity modification
- Reducing running volume and hills while the tendon settles.
- Heel lift
- Temporarily reduces tension on the tendon.
- Boot immobilization
- Short-term rest for severe flares.
- Shockwave or regenerative therapies
- Considered for stubborn cases; your doctor will discuss whether they are appropriate.
When is surgery considered?
Surgery is considered when symptoms persist for roughly six months despite a well-run rehabilitation program, or when imaging shows a significant tear.
Surgery removes the damaged tendon tissue and repairs the tendon. If a large portion of the tendon is affected, a nearby tendon may be transferred to reinforce it.
Related procedures
What is recovery like?
Non-surgical recovery takes weeks to months of progressive loading. After surgery, patients generally spend several weeks protected in a boot, followed by months of rehabilitation before returning to sport.
Frequently asked questions
Should I stretch a painful Achilles tendon?
Gentle stretching can help, but strengthening is usually more important. Aggressive stretching of an irritated tendon can make it worse.
Can Achilles tendinitis lead to a rupture?
A degenerated tendon is more vulnerable, which is one reason ongoing pain should be evaluated rather than pushed through.
Is it tendinitis or tendinosis?
Most long-standing cases involve degeneration (tendinosis) more than inflammation, which is why loading exercise works better than rest alone.