Achilles Tendinitis

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Understanding Achilles Tendinitis: Causes, Symptoms, and Treatments

The human body is a complex, well-oiled machine, with each part playing a significant role in maintaining our overall health and function.

However, when even a single cog in this intricate machinery malfunctions, the impact can be debilitating. 

An important part of our musculoskeletal system is the Achilles tendon, the largest tendon in the body, which, when inflamed, results in a condition known as Achilles tendinitis.

Understanding this condition’s causes, symptoms, and treatments can help us better manage our musculoskeletal health and prevent potential long-term damage.

Let’s get started!

Anatomy of the Achilles Tendon

The Achilles tendon, a band of fibrous tissue, connects the calf muscles to the heel bone. It’s located at the back of the lower leg and is crucial in various physical activities.

The contraction of the calf muscles tightens the Achilles tendon, which then pulls on the heel, enabling activities like walking, running, and jumping.

Given its pivotal role in facilitating movement, the Achilles tendon frequently withstands significant stress. It acts like a spring during running and jumping, absorbing shock and returning energy.

However, this persistent demand also makes it susceptible to injury and conditions such as Achilles tendinitis.

Causes of Achilles Tendinitis

Physical Activities and Sports Leading to the Condition

  • High-impact Sports: Sports that involve a lot of running, jumping or sudden changes in direction, like football, basketball, and tennis, can put undue stress on the Achilles tendon, causing inflammation.
  • Sudden Increase in Activity: A rapid escalation in the intensity or duration of exercise without adequate conditioning can lead to Achilles tendinitis.
  • Improper Technique: Running with poor form or on uneven surfaces can increase strain on the tendon, causing damage over time.
  • Natural Aging: As we age, our tendons naturally lose their elasticity and become more prone to injury, including Achilles tendinitis.
  • Bone Spurs: Older individuals may develop extra bone growths, known as spurs, which can rub against the tendon, causing irritation and inflammation.
  • Degeneration: Long-term wear and tear can cause degenerative changes in the tendon, increasing the risk of inflammation and ruptures.

Other Potential Risk Factors

  • Overuse: Repetitive stress on the tendon due to lack of rest or overtraining can cause inflammation.
  • Poor Footwear: Shoes that do not support the foot correctly can put additional strain on the Achilles tendon.
  • Underlying Health Conditions: Conditions like obesity, high blood pressure, and diabetes can increase the risk of developing Achilles tendinitis.

Common Symptoms of Achilles Tendinitis

Common signs and symptoms include:

  • Pain and stiffness along the Achilles tendon in the morning
  • Pain along the tendon or back of the heel that worsens with activity
  • Severe pain the day after exercising
  • Thickening of the tendon
  • Swelling is present all the time and gets worse throughout the day with activity.
  • If you notice a sudden “pop” in the back of your calf or heel, you may have ruptured (torn) your Achilles tendon.

Doctors can better diagnose Achilles tendinitis. So if you feel any symptoms, you should get a checkup.

How to Differentiate from Other Foot/Ankle Injuries?

Achilles tendinitis pain typically begins as a mild ache in the back of the leg or above the heel after running or engaging in sports. This distinguishes it from conditions like plantar fasciitis, which typically causes pain under the heel, or ankle sprains, which cause pain around the ankle.

When to Seek Medical Help?

If you experience persistent pain around the Achilles tendon, or if the pain worsens after exercise or activity, it’s essential to seek medical help.

Immediate medical attention should be sought if the pain or swelling is severe or if there’s a popping sound, which could indicate an Achilles tendon rupture.

Diagnosing Achilles Tendinitis

The Role of Physical Examination

In diagnosing Achilles tendinitis, a physical examination plays a crucial role. Doctors often apply pressure to the affected area or ask the patient to stand on their toes to see if the pain is reproduced.

Imaging Tests and Their Relevance

Imaging tests such as X-rays, ultrasound, or MRI scans can be used to visualize the tendon and surrounding structures. These tests can help detect Achilles tendon ruptures or determine the extent of tendon damage.

How is a Definitive Diagnosis Made?

A definitive diagnosis of Achilles tendinitis is made based on the physical examination, patient’s history, and imaging tests. This thorough process ensures that the condition is not mistaken for other foot or ankle injuries, and an appropriate treatment plan can be implemented.

Treatment Options for Achilles Tendinitis

When dealing with Achilles tendonitis, treatment typically begins with less invasive, non-surgical methods, with surgical intervention considered if conservative treatments fail to provide relief. Moreover, ongoing research offers promising emerging therapies for managing this condition.

Non-surgical Treatments

The first line of defence in treating Achilles tendinitis includes several non-invasive methods:

  • Rest and Ice: The simplest remedy often involves resting the affected foot and applying ice to reduce inflammation and speed healing.
  • Physical Therapy: Specific exercises designed to tight calf muscles can help relieve stress on the damaged tendon tissue and promote recovery.
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and inflammation.

Surgical Treatments and When They’re Necessary

Surgical intervention may be considered if pain continues despite non-surgical treatments:

  • Achilles Tendon Surgery: In cases of severe Achilles tendon injuries or rupture, Achilles tendinitis surgery may be necessary to repair the damaged tendon.
  • Achilles Tendinopathy Surgery: This type of surgery is designed to remove the unhealthy part of the tendon and stimulate the growth of new tendon tissue.
  • Foot and Ankle Surgery: Occasionally, surgical intervention may be required to correct related foot and ankle issues contributing to tendon inflammation.

Emerging Treatments and Therapies

Advances in medical science have led to the development of new treatments:

  • Platelet-Rich Plasma (PRP) Therapy involves injecting the patient’s blood components into the affected area to stimulate healing.
  • Shock Wave Therapy: High-energy shock waves are used to stimulate the healing process in the damaged tendon tissue.
  • Stem Cell Therapy: This experimental therapy uses the patient’s stem cells to promote the repair and regeneration of damaged tissues.

Prevention of Achilles Tendinitis

The risk of Achilles tendinitis can be mitigated through a combination of mindful practices. This includes choosing the right footwear, adhering to proper exercise routines, and maintaining a healthy lifestyle.

Choosing the Right Footwear

The importance of proper footwear cannot be overstated when preventing Achilles tendinitis.

  • Support: Choose shoes that provide ample support, particularly in the arch and heel area. This can help maintain proper foot alignment and prevent excessive strain on the Achilles tendon.
  • Cushioning: Shoes with good cushioning can help absorb the shock that would otherwise be absorbed by the Achilles tendon, especially during high-impact activities like running or jumping.
  • Fit: Avoid shoes that are too tight or too loose. Ill-fitting shoes can alter your gait, putting undue stress on the Achilles tendon and potentially leading to tendinitis.

Adopting Proper Exercise Routines

Being mindful of your exercise routines can significantly reduce the chances of developing Achilles tendinitis.

  • Gradual Progression: Avoid sudden increases in the intensity or duration of exercise. Instead, gradually build up your activity levels to give your Achilles tendon time to adapt to the increased demands.
  • Strength Training: Incorporate exercises that strengthen the calf muscles into your routine. Strong calf muscle can reduce the load on the Achilles tendon, decreasing the risk of inflammation.
  • Warm-up and Cool-down: Always take the time to warm up before exercising and cool down afterward. These practices increase blood flow to the muscles and tendons, preparing them for the activity and aiding recovery afterward.

Maintaining Overall Health

The health of your Achilles tendon is intrinsically linked to your overall health.

  • Healthy Weight: Maintaining a healthy weight can significantly reduce the strain on the Achilles tendon. Excess weight can add unnecessary stress to the tendon, increasing the risk of inflammation.
  • Nutrient-rich Diet: Consuming a balanced diet rich in essential nutrients can help support tissue health, including tendons. Specific nutrients like Vitamin C, which is critical for collagen production, can help maintain the structural integrity of the Achilles tendon.
  • Manage Chronic Conditions: Chronic health conditions like diabetes and high blood pressure, if poorly managed, can affect the health of your Achilles tendon. Therefore, keeping these conditions under control is crucial for preventing Achilles tendinitis.

With these proactive measures, the risk of Achilles tendinitis can be significantly lowered. But remember, prevention is an ongoing process that requires consistent effort and attention to your overall health and well-being.


Understanding Achilles tendinitis, its causes, symptoms, treatments, and, most importantly, preventive measures is crucial for maintaining our foot and ankle health.

Whether through conservative treatments like physical therapy or advanced surgical procedures, numerous options are available for treating Achilles tendinitis. 

However, remember the age-old adage, “Prevention is better than cure.”

We can minimise the risk of developing this painful condition by paying heed to our training routines, footwear, and overall health. Stay active, and stay safe! Book a treatment today!

Kula Health

Diarmuid Hegarty

Diarmuid is the Principal Physiotherapist here at ReSync Physiotherapy. He has a wealth of experience in both private practice settings, in UK, Ireland, Australia and New Zealand. If you wish to book in with Diarmuid for an Assessment - Follow this link to Book Online Now.