Achilles Tendonitis

Overview

​

The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles to the heel bone (calcaneus). It plays an essential role in walking, running, jumping, and pushing off the ground. Achilles tendonitis develops when repetitive stress exceeds the tendon's ability to recover, resulting in pain, stiffness, and sometimes thickening or degeneration of the tendon.

​

There are two primary types of Achilles tendonitis:

​

• Insertional Achilles tendonitis: Affects the tendon where it attaches to the heel bone and may be associated with calcification, bone spurs, or Haglund's deformity.

• Noninsertional Achilles tendonitis: Affects the middle portion of the tendon, typically 2–6 centimeters above the heel, and commonly develops from repetitive loading.

​

Although often called tendonitis, persistent symptoms may be more accurately described as Achilles tendinopathy, which involves changes in tendon structure rather than inflammation alone.

Signs & Symptoms

Symptoms of Achilles tendonitis may develop gradually and often worsen with repetitive activity. Common findings include:

​

• Posterior heel or ankle pain: Discomfort along the Achilles tendon or directly behind the heel.

• Morning stiffness: Tightness or pain with the first steps after waking or prolonged sitting.

• Activity-related pain: Symptoms during running, jumping, climbing stairs, or walking uphill.

• Swelling or thickening: Enlargement or localized tenderness along the tendon.

• Reduced flexibility: Tight calf muscles or difficulty bending the ankle upward.

• Pain with footwear: Irritation from the back of shoes, particularly with insertional tendonitis.

• Decreased push-off strength: Discomfort or weakness when rising onto the toes.

​

Symptoms may initially improve as the tendon warms up during activity, only to return afterward or the following morning.

​

Evaluation & Diagnosis

​

Diagnosing Achilles tendonitis begins with a detailed examination of the foot, ankle, and lower leg. Your podiatrist will assess the location of tenderness, tendon thickness, ankle range of motion, calf flexibility, and strength. A review of footwear, exercise habits, recent activity changes, and foot mechanics can help identify contributing factors. Imaging may be recommended based on examination findings:

​

• Digital X-rays: Evaluate heel bone spurs, calcifications, and bony abnormalities such as Haglund's deformity.

• Diagnostic ultrasound: Can assess tendon thickening, structural changes, and suspected partial tears.

• MRI: May be appropriate when a significant tendon injury is suspected, the diagnosis remains uncertain, or surgery is being considered.

​

The examination also helps distinguish Achilles tendinopathy from retrocalcaneal bursitis, posterior ankle impingement, and partial or complete Achilles tendon tears.

​​​

​Treatment for Achilles Tendonitis

​

Most cases of Achilles tendonitis can be managed without surgery. Treatment depends on the location of the affected tendon, severity of symptoms, duration of the condition, and the patient's activity goals. Conservative treatment options may include:

​

• Activity modification: Temporarily reducing running, jumping, or other activities that place excessive stress on the tendon.

• Medical Laser Therapy: Class IV medical laser therapy is highly effective at reducing inflammation and stimulating the body's response to repairing degenerative tissue.

• Physical therapy: Progressive calf-strengthening and tendon-loading exercises designed to improve tendon capacity and function.

• Heel lifts and supportive footwear: Reducing strain on the Achilles tendon and minimizing irritation at the back of the heel.

• Custom orthotics: Addressing selected biomechanical factors that may contribute to repetitive tendon stress.

• Immobilization: Short-term use of a walking boot for severe pain or cases requiring temporary protection.

• Pain management: Ice and appropriate anti-inflammatory medications for short-term symptom relief.

​

Rehabilitation differs between insertional and non-insertional Achilles tendinopathy. For example, heel-drop exercises below the level of a step may aggravate insertional tendon symptoms and should not be used indiscriminately. Surgical treatment may be considered for persistent cases that do not improve after an appropriate course of conservative care. Depending on the underlying pathology, procedures may involve removing degenerative tendon tissue, addressing calcifications or bone spurs, and repairing the Achilles tendon.