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Achilles Tendon Injury Overview

by Jaydee Vykoukal, PT, DPT November 18, 2020 0 Comments

Achilles tendonitis pain

The Achilles tendon is in constant use and endures with all weight-bearing activities. Since it is a high traffic area, an Achilles tendon injury can easily occur without proper care or rest. Achilles tendonitis results in weakness, inflammation, pain, and stiffness that can interfere with your daily life. Thankfully, treatments are simple and effective. Read on to learn what causes Achilles tendonitis and how to treat and prevent it.

Tendonitis of the Achilles

Onset of Achilles tendonitis is typically due to overuse of the tendon, causing irritation and inflammation. The Achilles tendon attaches the calf muscle to the foot and withstands the force of standing, balancing, running, walking, and stopping. Tight calves also increase the risk of Achilles tendonitis.

Types of Achilles Tendonitis

There are different types of Achilles tendonitis. Each type may require a slightly different approach for treatment and recovery.  Here are the most common types.

  • Insertional Achilles Tendonitis

    Insertional Achilles tendonitis pain typically occurs at the back of the heel, where the tendon fibers have deteriorated due to inflammation. Pain progresses over time and is more pronounced after intense pushing movements.

  • Acute Achilles Tendonitis

    Acute Achilles tendonitis refers to a sudden onset of new pain, swelling, or an inability to push off with the toes. Although the symptom onset is abrupt, it is typically a result of overuse or sudden changes in activity level. The tendons simply hit a “breaking point” where symptoms occurred. Pain occurs between the bottom of the calf and the top of the ankle.

  • Chronic Achilles Tendonitis

    Chronic Achilles tendonitis is pain that persists, and often worsens, over a period of 6 weeks or more. Chronic Achilles tendonitis results from a prior Achilles tendon injury and is common in runners. Often, chronic issues can be avoided when acute symptoms are addressed quickly and sustainably.

What Causes Achilles Tendonitis?

Achilles tendonitis is a wear-and-tear injury typically caused by excessive pressure and stress to the tendon. Here are three common issues that contribute to the development of Achilles tendonitis.

1. Sudden Activity Increase

While the Achilles tendon is designed to sustain a high level of stress, suddenly increasing your activity or exercise intensity can cause tendonitis of the tendonitis. Adding miles too quickly to your running or walking routine can result in repetitive stress to the legs and ankles if they are not ready for the increase in load, which can lead to injury. Increase exercise intensity in a slow, progressive manner to avoid injury to the tendon, or a rupture.

2. Tight Calf Muscles

The Achilles tendon attaches the calf muscle to the heel.  This means that a tight calf muscle puts extra stress on the tendon itself. This puts the lower leg out of balance with daily activities and movements, possibly leading to injury.

How to Stretch Your Achilles Tendon

3. Bone Spur

Heel spurs, small bony growths, often form near the insertion site of the Achilles attachment on the heel.  This can cause the tendon to become irritated as it rubs against the bony projection, creating inflammation and pain. Bone spurs in the heel are often a result of an imbalance in the foot and ankle, such as tight calf muscles. If bone spurs aren’t addressed, the Achilles tendonitis they cause can become severe.

4. Poor Lower Leg Biomechanics

The calf muscles are meant to work in balance with the rest of the lower body to optimally coordinate movement. Some common problems that result in poor biomechanics and Achilles tendonitis include flat arches, over-pronation of the ankle with walking and running, glute weakness, poor hip alignment and even weak core muscles.

Achilles Tendonitis Symptoms

Symptoms of Achilles tendonitis are often noticed first thing in the morning and during moderate to intense physical activity. Pain near the heel is relieved by taking weight off the tendon by sitting or walking flat-footed. Recognizing the symptoms and taking action is key to prompt, effective treatment. Here are common signs of Achilles tendonitis.

  • Morning Pain

    Achilles tendonitis is typically more acute in the morning and is often accompanied with stiffness and swelling. The sudden pressure on your tendon when you get out of bed causes pain to flare up.

  • Heel Pain

    Ongoing pain in the heel region is often accompanied by tightness. Activities involving plantar flexion of the foot (pointing the toes) or pushing through the toes further irritates the pain.

  • Thickening of the Tendon

    A lump on the back of the leg may indicate the Achilles tendon fibers have begun to break down, swell, and thicken. This thickening will be accompanied by tightness and pain during weight-bearing activities.

  • Ruptured Achilles Tendon

    Achilles tendonitis can lead to a ruptured tendon if symptoms are ignored and rest and treatment isn’t properly initiated as soon as possible. Immediately beginning the RICE protocol and limiting your activity will prevent a ruptured tendon. Always use your symptoms as a gauge to preserve tissue health and function as best you can.

Achilles Tendonitis Relief

Treatment for Achilles tendonitis might include rest, pain relief, physical therapy, exercise, massage, injections, and surgery if necessary. Achilles tendonitis recovery time depends on paying attention to your symptoms and following your doctor’s and/or physical therapist’s treatment plan. If symptoms are severe, you will need to avoid weight-bearing activity, such as running or strength training, which can prolong the injury and even rupture the tendon. Otherwise, you may find you simply need to reduce your activity level and intensity for a few weeks while you complete a home exercise program specific to Achilles tendonitis.

Learn more ways to find relief here.

Recovering from Achilles Tendonitis

To prevent Achilles tendonitis, it’s important to restore balance to the lower leg, including the intrinsic ankle and foot muscles. Implement a stretching and strengthening program to prevent tightness and overuse in the tendon. Remember to increase exercise intensity progressively, and consult your doctor immediately if you experience severe or persistent pain.


Achilles Tendonitis Products


Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.

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