Achilles Tendonitis

What Is Achilles Tendonitis?

Achilles tendonitis is inflammation (irritation and swelling) of the Achilles tendon. The Achilles tendon is a band of tough tissue on the back of the foot. It connects the heel bone to the calf muscles. 

What Are the Signs & Symptoms of Achilles Tendonitis?

Achilles tendonitis causes pain above the heel and in the lower leg, especially after running or doing other physical activities. The pain often gets worse when exercising and better with rest.

People with Achilles tendonitis also might have:

• stiffness and soreness in the heel, especially in the morning
• swelling or hard knots in the Achilles tendon
• a creaking or crackling sound when moving the ankle or pressing on the Achilles tendon
• weakness in the affected leg
• pain when pointing the foot
• pain with pressure from shoes

What Causes Achilles Tendonitis?

Achilles tendonitis is usually an overuse injury (when repeated movements injure part of the body). It also can happen when someone:

• suddenly increases their exercise
• doesn’t warm up the calf muscles before exercising
• exercises in worn out, non-supportive, or poor-fitting shoes or sneakers
• does not stretch the Achilles tendon and back of the leg after activity
• has a direct blow to the area

Achilles tendonitis usually affects people who play sports that put strain on the heel, such as running, jumping, tennis, basketball, figure skating, skiing, or dancing.

How Is Achilles Tendonitis Diagnosed?

To diagnose Achilles tendonitis, health care providers:

• ask about symptoms
• do an exam

Occasionally, doctors order imaging tests such as an X-ray or MRI (if they think the Achilles tendon may be torn).

How Is Achilles Tendonitis Treated?

Treatment for Achilles tendonitis starts with taking a break from the activity that led to the injury. It’s usually OK to do non-weight bearing exercises such as swimming, biking, and stretching activities like yoga. If someone with Achilles tendonitis does not rest, the tendon can become more damaged.

Your health care provider also may recommend:

• stretching the Achilles for 30 seconds at a time 3–4 times a day
• putting ice or a cold pack on the heel every 1–2 hours for 15 minutes at a time. (Put a thin towel over the skin to protect it from the cold.)
• taping or using athletic wrap around the Achilles tendon and ankle
• raising the foot above the level of the heart to help with swelling
• taking ibuprofen (Advil, Motrin, or store brand) to help with pain and swelling
• strengthening and stretching muscles through physical therapy or an at-home exercise program
• wearing a walking boot and using crutches to keep the tendon still
• using shoe inserts (also called shoe orthotics) from your health care provider or someone trained in fitting orthotics
• applying soft pads to the Achilles if it rubs against a shoe surface or wearing different shoes
• strengthening the surrounding muscles to take stress off the Achilles and help support the ankle

Steroid injections in or around the Achilles tendon have been linked to tendon rupture and aren't recommended.

Rarely, a person might need surgery if the symptoms do not go away after following the health care provider's recommendations.

What Else Should I Know?

With rest, Achilles tendonitis usually gets better within 6 weeks to a few months. To lower your risk of Achilles tendonitis again:

• Stay in good shape year-round. Drink plenty of water to flush out inflammation, and eat healthy whole grains, vegetables, and fruits to decrease inflammation.
• Increase the intensity and length of your exercise sessions gradually. Experts recommend just a 10% increase in activity per week. 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 and cool down by stretching after.
• Stretch your legs, especially your calves, hamstrings, quadriceps, and thigh muscles. After activity, hold your stretches for 30 seconds and repeat several times a day.
• Wear shoes that fit properly and are made for your sport. Replace them 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.
• Do different kinds of exercise, such as yoga, biking, and swimming. Work different muscle groups to keep yourself in good shape overall and to prevent overusing individual muscles.

If things don't improve, see your doctor, as it may be a sign that you have a different condition.