AAOS OrthoInfo says Achilles tendinitis is typically not related to a specific injury, and that the problem results from repetitive stress to the tendon [1].
This page sets out what the sources say about why the Achilles tendon becomes painful, the usual signs, and the signs that should not wait.
- What is the Achilles tendon and what does it do?
- What causes pain in the Achilles tendon?
- What are the usual signs?
- How is overuse pain different from a tear?
- What do the sources say about easing the pain?
- When is urgent help needed?
- What should I do next?
What is the Achilles tendon and what does it do?
The Achilles tendon is the largest tendon in the body [1].
It connects the calf muscles to the heel bone and is used when you walk, run, climb stairs, jump, and stand on your tip toes [1].
What do tendinitis and tendinopathy mean?
AAOS OrthoInfo defines tendinitis (also spelled “tendonitis”) as acute inflammation of a tendon [1].
AAOS OrthoInfo adds that you may also come across the term “tendinopathy”, which is used to describe a condition in which the tendon develops microscopic degeneration (wear) as a result of chronic damage over time [1].
AAOS OrthoInfo says tendinitis and tendinopathy are both common terms which essentially refer to the same problem [1].
What causes pain in the Achilles tendon?
AAOS OrthoInfo describes Achilles tendinitis as a common condition that occurs when the large tendon that runs down the back of the lower leg becomes irritated and inflamed [1].
AAOS OrthoInfo says other factors can make a person more likely to develop Achilles tendinitis, including [1]:
- A sudden increase in the amount or intensity of exercise activity [1].
- A change in shoewear, which can also lead to increased strain on the Achilles tendon [1].
- Tight calf muscles, which put extra stress on the Achilles tendon, especially where it attaches (inserts) to the heel bone [1].
In athletes, a review of conservative management says the most common cause is excessive loading with inadequate recovery time between training sessions [2].
The same review says not all cases are sport related, and that increases in work or daily activity can contribute to excessive loading [2].
More on how the tendon changes
AAOS OrthoInfo says that over time, the fibers may begin to break down and develop tiny tears [1].
The review says changes in tendon structure can occur before an athlete has any symptoms and are a risk factor for developing Achilles tendinopathy [2].
What are the usual signs?
AAOS OrthoInfo lists these symptoms of Achilles tendinitis [1]:
- Pain along the tendon or back of the heel that worsens with activity [1].
- Pain and stiffness along the Achilles tendon in the morning [1].
- Swelling that is present all the time and gets worse throughout the day or with activity [1].
- Thickening of the tendon [1].
- Pain on the back of the heel when you wear shoes [1].
Can there be few signs at first?
In athletes, the review says pain with activity is generally preceded by weeks or months of morning stiffness and minor pain, often ignored by both the athlete and the clinician as long as the athlete can participate in sport [2].
How is overuse pain different from a tear?
Achilles tendinitis is different than an Achilles rupture, a condition where the tendon becomes separated off the heel bone or completely torn in half [1].
Achilles tendon rupture typically results from a sudden injury [1].
AAOS OrthoInfo says a sudden pop in the back of the calf or heel may mean a torn Achilles tendon [1].
AAOS OrthoInfo says to see your doctor immediately if you think you may have torn your tendon [1]. The urgent-signs list further down this page also says where to go.
- Read more about Achilles tendon rupture.
- Read more about Achilles tendonitis.
Owner clinical review required · not a release assetWhat do the sources say about easing the pain?
AAOS OrthoInfo says the first step in reducing pain is to decrease or even stop the activities that make the pain worse [1].
AAOS OrthoInfo says that if you regularly take part in high-impact exercises (such as running), switching to low-impact activities will decrease the amount of stress on the Achilles tendon [1].
A review of conservative management says treatment should be centred on activity modification and progressive tendon-loading exercises (exercises that put gradually more load on the tendon) to promote tendon remodelling and restoration of calf-muscle function [2].
The same review says the Achilles tendon will adapt to the loading demands placed on it [2]. This describes how the tendon responds to load. It is not a promise about how any one person will recover.
AAOS OrthoInfo says physical therapy is very helpful in treating Achilles tendinitis [1].
What does treatment usually include?
AAOS OrthoInfo lists anti-inflammatory pain medications, activity modification, shoewear modification, and physical therapy exercises as the mainstays of nonsurgical treatment [1].
How long can it take?
AAOS OrthoInfo says that in most cases of Achilles tendinitis, nonsurgical treatment will provide acceptable pain relief, although it may take a few months for symptoms to improve significantly [1].
AAOS OrthoInfo also says that even with early treatment, the pain may last longer than 3 months [1].
The review of conservative management describes Achilles tendinopathy as a painful overuse injury that is extremely common in athletes [2]. The review also says recovery from Achilles tendinopathy can take a year or more [2].
AAOS OrthoInfo says surgery for Achilles tendinitis should be considered only if the pain does not improve after 6 months of nonsurgical treatment [1].
When is urgent help needed?
The list below covers the signs that should not wait for a routine appointment.
What should I do next?
If Achilles or heel pain is not settling, or you are unsure what is causing it, an assessment is a sensible next step. The assessment brings together the patient’s story, an examination and any tests that help, so that the patient and the surgeon can decide together. It looks at the structure involved, the patient as a whole person and the goal they want to return to. An appointment supports an informed decision. It is not a commitment to surgery.
- Read about the Foot and Ankle Hub.
- Read about shoes and foot pain.
This page provides general information and cannot diagnose an individual condition. OrthoKinetics does not provide emergency or urgent care through this webpage or its WhatsApp contact.
References
- AAOS OrthoInfo. Achilles Tendinitis. https://www.orthoinfo.org/diseases–conditions/achilles-tendinitis
- Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020;55(5):438-447. doi:10.4085/1062-6050-356-19. https://pmc.ncbi.nlm.nih.gov/articles/PMC7249277/
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