The Achilles tendon is the large band of tissues connecting the muscles in the back of your lower leg to your heel bone. Achilles tendonitis—sometimes spelled Achilles tendinitis—is an injury that occurs when this band becomes inflamed or irritated, resulting in heel pain.
There are two types of Achilles tendonitis. Insertional Achilles tendonitis is diagnosed when the inflammation occurs where the tendon attaches to the heel bone whereas, in non insertional Achilles tendonitis, the irritation is more in the middle of the tendon.
Causes of Achilles Tendonitis
There are many potential causes of Achilles heel pain and irritation.
- Overtraining: When you place a large amount of stress on your Achilles tendon, it can become inflamed from tiny tears that occur during the activity. Achilles tendonitis is often a result of overtraining or doing too much too soon. Excessive hill running can contribute as well.
- Changing exercise routine: As you get more fit, it’s normal to increase exercise intensity and duration. Make these increases too fast, without allowing the body to adjust, and you may notice a sore Achilles tendon.
- Calf muscle tightness: A tight calf is another potential cause of Achilles tendon pain. Though, research has connected chronic Achilles tendon issues with weak calf muscles as well.
- Wearing different shoes: Changes in footwear, such as switching to a minimalist shoe, can aggravate the Achilles tendon and cause heel pain.
- Modifying running technique: Changing running style by transitioning to a forefoot strike pattern and running on the balls of your feet can also contribute to Achilles tendonitis risk.
- Flat feet: Flattening of the arch of your foot can place you at an increased risk of developing Achilles tendonitis because of the extra stress placed on your Achilles tendon when walking or running.
- Overpronation: If your foot rolls inward when you walk or run, this could increase your risk of injuring the Achilles tendon. Studies suggest that this is because it disrupts blood flow along the tendon.
- Being overweight: Having a higher body mass index (BMI) is another risk factor, with overweight individuals having a 2.6 greater chance of developing Achilles heel pain and obese individuals have a 6.6 greater risk.
You’re more at risk for Achilles tendonitis if you’re inflexible, especially in your calf muscles, or if you overpronate. Achilles heel pain may also be caused by changes in your exercise routine, footwear, or running style.
Common Running Injuries
Symptoms
The signs and symptoms of Achilles tendonitis often develop gradually and can include:
- Heel pain and stiffness. It’s common to experience pain and stiffness in the back of your ankle, especially when you first get out of bed or after sitting for a long period of time. This pain sometimes lessens as you do a warm-up run and may even disappear as you continue running. But once you stop, the pain often returns and may feel even worse.
- Swelling that worsens throughout the day. There may also be mild swelling or a small bump on your Achilles tendon. Depending on how long you’ve been experiencing these symptoms, swelling may or may not exist.
- Achilles band thickening. You might notice a thickening of your Achilles tendon, which is known as Achilles tendinopathy.
- Bone spur. If you have a bone spur, you might also have Achilles tendonitis—insertional Achilles tendonitis, to be more specific.
Feeling a “pop” in the Achilles that is accompanied by sharp pain can be a sign that you’ve ruptured your tendon, typically requiring a doctor’s visit to determine the extent of the rupture or tear.
Diagnosis
Diagnosing Achilles tendonitis generally begins with the doctor physically examining your foot and ankle area. This involves looking for some of the symptoms of this condition, such as the swelling, Achilles band thickening, and the presence of bone spurs.
If Achilles tendonitis is suspected, your doctor may request further testing to know for sure. Ultrasounds, x-rays, and magnetic resonance imaging (MRI) tests can all help identify whether this condition exists and, if so, determine the extent of the tendon damage.
Achilles Tendonitis Treatment
Treatments for Achilles tendonitis fall into two basic categories: at-home treatment options and treatments that are a bit more advanced and, therefore, may be prescribed by a doctor.
At-Home Achilles Tendonitis Treatment
There are a few things you can do at home to begin easing the heel pain that occurs with Achilles tendonitis. One of the simplest is to use the R.I.C.E. method.
- Rest. Take a few days off from running but make sure you move the injured ankle through its full range of motion and perform gentle calf and ankle stretches to maintain flexibility. Avoid physical activities that make your heel pain worse, doing low-impact exercises or cross-training instead to stay fit while the Achilles heals.
- Ice. Ice the Achilles for up to 20 minutes at a time, as needed during the day, to help reduce swelling and heel pain.
- Compression. Wrap the Achilles to compress the area. Both elastic wraps and surgical tape can be used for this purpose.
- Elevation. When possible, lie down with your foot raised above heart level.
If the pain is bothersome, over-the-counter pain relievers may provide some relief. Though, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can increase your risk of heart attack, stroke, ulcers, and holes in the digestive tract, so talking to your doctor can help you determine if these medicines are safe for you to take.
Using foot orthotics may help as well. Research shows that placing a heel lift in your shoe can reduce the load placed on the Achilles tendon.
The American Academy of Orthopaedic Surgeons indicates that, even if you start treating your heel pain right when it starts, it can several months for the pain to subside; and it may take longer (up to 6 months) if you’ve had pain for some time before beginning treatment.
More Advanced Achilles Tendonitis Treatments
If self-care at home doesn’t work, it’s important to get the injury treated because if the tendon continues to sustain small tears through movement, it can rupture under excessive stress.
Depending on the extent of the damage, your doctor may suggest that you do physical therapy. Physical therapy can help the tendon heal and repair itself over a period of several weeks.
For more severe cases of Achilles heel pain, extracorporeal shockwave therapy or even surgery may be recommended. Surgical procedures can be conducted to elongate your calf muscles, remove heel spurs or damaged areas of the tendon, or repair tendon damage.
Prevention
Making the soft tissue in the lower leg stronger can potentially help reduce injury risk to this area because it is more able to withstand physical exercise and movements. This includes:
- Strengthening your Achilles tendon
- Strengthening your calf muscles
- Strengthening your intrinsic foot muscles (especially if you wear a minimalist shoe)
When running, be especially careful that you don’t overdo it, such as when introducing speed training or hill training into your regimen. And don’t do a hard workout two days in a row.
Also, work low-impact cross-training activities, such as cycling and swimming, into your training. This enables you to stay fit while reducing the load on the Achilles tendon. A proper warm-up before these workouts can further prevent Achilles injuries.
Because having a higher BMI is associated with an increased risk of Achilles tendonitis, achieving and maintaining a healthy weight can be helpful as well.
If you’re just getting started with your training, start slowly, increasing your overall weekly mileage by no more than 10% per week.
Frequently Asked Questions
Can I walk and exercise if I have Achilles tendon pain?
You can walk with Achilles tendon pain, as long as the pain is not too severe. Though, you might want to avoid high-impact exercises until the pain subsides to keep from damaging the Achilles tendon even more or making the pain worse.
What is the fastest Achilles tendonitis treatment?
No one treatment appears to be superior to another for easing Achilles tendon pain. Your doctor can help you decide the best treatment option for you based on your condition’s severity and level of pain.
Why do I have Achilles tendon pain?
Achilles heel pain has many potential causes ranging from overtraining to changing up your fitness routine to overpronating when you walk. A doctor, physical therapist, or athletic trainer can help identify the cause of your Achilles tendon pain as well as recommending a potential course of treatment.
Can Achilles tendonitis go untreated?
It isn’t recommended that you leave Achilles tendonitis untreated as doing so can lead to long-term issues that may ultimately make it hard to even walk.
Is It Okay to Take a Week Off From Running?
