Kim didn't do much over the summer except hang out at the pool. When she did wear something on her feet, it was often heels. But as soon as school started, she laced on a pair of sneakers and went out for the cross-country team, running a couple of miles each day.

Within a week, Kim noticed a pain just above her heel. At first it wasn't too bad, and she kept running. But before too long, the pain got worse and wouldn't go away. Kim had to stop running, and her coach told her to go see a doctor. The doctor examined her heel and told Kim she had Achilles tendonitis.

What Is Achilles Tendonitis and Who Gets It?

Your Achilles tendon is located at the back of your foot, just above your heel. It connects your heel to the two muscles of your calf and helps your foot push forward every time you take a step.

If the tendon becomes swollen or irritated due to overuse, it can lead to the painful condition called Achilles tendonitis. If Achilles tendonitis goes untreated, it can become a chronic condition that makes just walking around almost impossible.

Achilles tendonitis is a very common running injury. But it can also affect basketball players, dancers, or people who put a lot of repeated stress on their feet. It can be very painful.

What Are the Symptoms of Achilles Tendonitis?

Most cases of Achilles tendonitis start out slowly, with very little pain, and then grow worse over time. Some of the more common symptoms include:

• mild pain or an ache above the heel and in the lower leg, especially after running or doing other physical activities
• pain that gets worse when walking uphill, climbing stairs, or taking part in intense or prolonged exercise
• stiffness and tenderness in the heel, especially in the morning, that gradually goes away
• swelling or hard knots of tissue in the Achilles tendon
• a creaking or crackling sound when moving the ankle or pressing on the Achilles tendon
• weakness in the affected leg

How Is Achilles Tendonitis Diagnosed?

If you suspect you might have Achilles tendonitis, check in with your doctor so it doesn't get worse. Your doc will ask about the activities you've been doing as well as examine your leg, foot, ankle, and knee for range of motion.

If your pain is more severe, the doctor may also examine you to be sure you haven't ruptured (torn) your Achilles tendon. To check this, the doc might have you lie face down and bend your knee while he or she presses on your calf muscles to see if your foot flexes. Any flexing of the foot means the tendon isn't completely torn.

It's possible that the doctor might also order an X-ray or MRI scan of your foot and leg to check for fractures, partial tears of the tendon, or signs of a condition that might get worse.

What Causes Achilles Tendonitis?

Achilles tendonitis is a common sports injury caused by repeated or intense strain on the tendon. But non-athletes also can get it if they put a lot of stress on their feet.

Other things that contribute to Achilles tendonitis include:

• An increase in activity. Starting a training program after a period of inactivity or adding miles or hills to a jogging regimen are two examples of things that put people at risk for Achilles tendonitis.
• Sports that require sudden starts and stops; for example, tennis and basketball.
• A change in footwear, or wearing old or badly fitting shoes. New shoes, worn-out shoes, or the wrong size shoes can cause a person's feet to overcompensate and put stress on the Achilles tendon. Additionally, wearing high heels all the time can cause the tendon and calf muscles to get shorter, and the switch to flat shoes and exercise can put extra strain on the heel.
• Running up hills. Going uphill forces the Achilles tendon to stretch beyond its normal range.
• Weak calf muscles, flat arches, or "overpronation" (feet that roll in when running). Overpronation makes the lower leg rotate inward and puts a twisting stress on the tendon.
• Exercising without warming up. Tight calf muscles or muscles that lack flexibility decrease a person's range of motion and put an extra strain on the tendon.
• Running or exercising on a hard or uneven surface.
• A traumatic injury to the Achilles tendon.

How Can You Prevent Achilles Tendonitis?

Take these steps to reduce your risk of Achilles tendonitis:

• Stay in good shape year-round and try to keep your muscles as strong as they can be. Strong, flexible muscles work more efficiently and put less stress on your tendon.
• Increase the intensity and length of your exercise sessions gradually. This is especially important if you've been inactive for a while or you're new to a sport.
• Always warm up before you go for a run or play a sport. If your muscles are tight, your Achilles tendons have to work harder to compensate.
• Get shoes that fit properly and are designed for your sport. If you're a jogger, go to a running specialty store and have a trained professional help you select shoes that match your foot type and offer plenty of support. Replace your shoes before they become worn out.
• Try to run on softer surfaces like grass, dirt trails, or synthetic tracks. Hard surfaces like concrete or asphalt can put extra pressure on the joints. Also avoid running up or down hills as much as possible.
• Vary your exercise routine. Work different muscle groups to keep yourself in good overall shape and keep individual muscles from getting overused.
• If you notice any symptoms of Achilles tendonitis, stop running or doing activities that put stress on your feet. Wait until all the pain is gone or you have been cleared to start participating again by a doctor.

How Should You Treat Achilles Tendonitis?

Most cases of Achilles tendonitis can be treated at home. Here's what to do:

• Stop doing the activity that led to the injury. Avoid putting stress on your legs and feet, and give your tendon plenty of time to fully recover.
• Use the RICE formula:
  • Rest: Don't exercise for a few days, or try an exercise that doesn't stress your feet, such as swimming. If necessary, your doctor may recommend that you use crutches or wear a walking boot to keep weight off your foot.
  • Ice: Apply ice or a cold compress to your tendon for 15 minutes or more after you exercise or if you feel pain in the tendon.
  • Compress: Use tape or an athletic wrap to keep swelling down and help support and immobilize the tendon.
  • Elevate: Lie down and raise your foot above the level of your heart, and if possible, try to sleep with your foot elevated. This will help keep the swelling to a minimum.
• Take anti-inflammatory medications. Painkillers like ibuprofen can help relieve pain and reduce swelling in the affected area.
• Stretch and exercise your ankles and calf muscles while you recover. Keeping your muscles, tendons, and ligaments strong and flexible will aid in your recovery and help you keep from reinjuring your Achilles tendon. A doctor or a physical therapist can help you come up with a good exercise program.
• Try a pair of prescription orthotic inserts for your shoes if your doctor thinks it will help. Sometimes orthotics can be helpful. Talk to your doctor or someone trained in fitting orthotics to find out if they might work for you.

Achilles tendon surgery is rare. It's usually only required if the tendon breaks, and then only as a last resort after other methods of therapy have been tried. Most cases of Achilles tendonitis will get better on their own with rest and minor treatment.

Reviewed by: Kathleen B. O'Brien, MD
Date reviewed: March 2011