Achilles Tendinitis

What is Achilles tendinitis?

Achilles tendinitis (also spelled tendonitis) is inflammation of the tissue that connects your calf muscle to your heel (Achilles tendon). Inflammation is your body’s response to injury or disease. Achilles tendinitis is a common condition in runners. When you run, your calf muscles help raise you up on your toes. Over time, this repetitive motion, combined with not giving your body enough time to rest, can cause painful inflammation.

Types of Achilles tendinitis

The two types of Achilles tendinitis describe the affected part of your tendon:

• Noninsertional Achilles tendinitis: The fibers in the middle of your tendon start to break down, swell and thicken. This type of Achilles tendinitis affects people who are more active.
• Insertional Achilles tendinitis: This type affects the lower part of your heel, where the tendon connects, or inserts, to your heel bone. It can affect anyone, even people who aren’t active. But it most commonly affects people who overuse the tendon, such as long-distance runners.

How common is Achilles tendinitis?

Achilles tendinitis is a common condition. It most often affects active people and athletes. About 24% of athletes will develop an Achilles tendon injury in their lifetimes.

What are the symptoms of Achilles tendinitis?

Achilles tendinitis symptoms affect the back part of your lower leg above your heel. You might notice:

• Heel pain and ankle pain.
• Stiffness or tenderness in your tendon.
• Leg weakness.
• Swelling around your Achilles tendon.

You may notice more discomfort:

• After you’re active or the day after exercising.
• As you climb stairs or go uphill.
• In the morning, with improvement throughout the day.

What is the main cause of Achilles tendonitis?

With Achilles tendinitis, overuse of your Achilles tendon causes swelling, irritation and inflammation. You can get Achilles tendinitis by being active on your feet. It’s usually not related to a specific injury — it happens because of stressing your tendon repeatedly. Because it’s difficult to avoid using your Achilles tendon, your body doesn’t have time to repair the injured tissue.

Who is at risk for Achilles tendinitis?

Achilles tendinitis is a common sports injury. People at high risk for Achilles tendinitis include those who:

• Play sports, especially sports that involve quick stops and starts.
• Run or dance.
• Have jobs that put stress on their feet and ankles, such as laborers.
• Participate in sports less frequently (“weekend warriors”), leaving their bodies less used to the stress.

You may also be at higher risk for Achilles tendinitis because of your anatomy (body shape and structure). For example, if you have:

• Tight or weak calf muscles.
• Bone spurs, an extra bone growth in your heel that rubs the tendon, causing pain.
• Flat arches.
• Overpronation, ankles that roll down and in when you walk.

What are the complications of Achilles tendinitis?

If you don’t rest or seek treatment for Achilles tendinitis, you may experience the following complications:

• Achilles tendinosis: Your Achilles tendon starts to degenerate (break down).
• Achilles tendon rupture: Your Achilles tendon separates from your heel bone, or tears or breaks completely.

How is Achilles tendinitis diagnosed?

Your healthcare provider will ask you about your symptoms and recent activity. They’ll perform a physical examination and look for signs of Achilles tendinitis or Achilles tendon rupture. They’ll check your range of motion and look for signs of bone spurs.

What tests will be done to diagnose Achilles tendinitis?

Your provider can often diagnose Achilles tendinitis based on the physical exam alone. You may need imaging to show the condition’s details or severity. Imaging exams may include:

• X-ray.
• Ultrasound.
• Magnetic resonance imaging (MRI).
• Computed tomography (CT).

What is the best way to get rid of Achilles tendonitis?

Your healthcare provider will first recommend nonsurgical treatment. It may take a few months for the pain to get better — especially if you’ve already had symptoms for a few months.

Nonsurgical Achilles tendinitis treatments include the RICE method:

• Rest: Stop doing activities that stress your tendon. Switch to low-impact activities, such as swimming, that put less stress on your Achilles tendon.
• Ice: Put ice on your tendon for up to 20 minutes, as needed throughout the day.
• Compression: Compress, or put pressure on, your tendon using an athletic wrap or surgical tape.
• Elevation: To reduce swelling, lie down and raise your foot on pillows so it’s above your heart.

Protect your tendon. Avoid walking up steep inclines or overstretching your tendon, such as by standing on a ladder rung. Wear:

• Supportive shoes, heel lifts or custom orthotics. Don’t walk barefoot.
• A splint at night to help your Achilles tendon stay stretched while you sleep.
• A walking boot or walking cast if the pain is severe.

Other nonsurgical Achilles tendinitis therapies that can help include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. Don’t take the medication for more than one month without talking to your provider.
• Exercises you can do at home, such as calf stretches.
• Physical therapy, which uses strengthening exercises, massage, stretching and running reeducation to help you feel better and regain your strength.
• Shockwave therapy, which uses strong sound waves to reduce pain and promote healing.
• Brisement, which is a treatment option in the earlier stages of Achilles tendinitis, before it progresses to Achilles tendinosis. Providers inject an anesthetic into the space around your tendon to break up scar tissue. You may need to have this procedure a few times.

When does Achilles tendinitis need surgery?

If you’ve tried nonsurgical methods for six months and you’re still in pain, talk to your provider. You may need surgery. A foot and ankle surgeon can suggest options based on your injury, age, preferences and activity level.

Surgical options include:

• Gastrocnemius recession: A surgeon lengthens your calf (gastrocnemius) muscles.
• Debridement and repair: If most of your tendon is healthy, the surgeon removes just the damaged part and stitches together the remaining healthy tendon. After the procedure, you’ll wear a boot or cast for a few weeks.
• Debridement with tendon transfer: If more than half of your Achilles tendon has damage, then there’s not enough of a healthy part to function. You’ll need an Achilles tendon transfer. Your surgeon takes the tendon that helps your big toe point down and moves it to your heel bone. Treatment gives the damaged tendon enough strength to function. You’ll still be able to move your big toe, walk and even run. But you may not be able to play sports competitively after this procedure.
• Hydrocision TenJet®: This minimally invasive, ultrasound-guided technique uses high-velocity saline to break up scar tissue in your tendon. The pressurized saline acts as a blade to selectively remove unhealthy tissue.

Complications of Achilles tendinitis surgery

Some people still experience pain after surgery. The other complication that can occur is a wound infection. Infections can be challenging to treat because of the location of the Achilles tendon.

How can I prevent Achilles tendinitis?

To reduce your risk of Achilles tendinitis:

• Warm up before you exercise or play sports. Focus on stretching exercises, especially stretching your calf muscles.
• Do a variety of exercises to avoid repetitive stress on your Achilles tendon.
• Increase the length and intensity of your exercises slowly rather than all at once.
• Keep your muscles active by staying in shape all year round.
• Wear supportive shoes that fit well.
• Avoid running uphill or on uneven ground.

If you notice symptoms of Achilles tendinitis, such as pain, stop what you’re doing and rest. Then, talk to your healthcare provider about next steps.

What is the outlook for people with Achilles tendinitis?

People can recover from Achilles tendinitis. But get treatment as soon as you feel symptoms. The longer you live with the pain, the harder and longer the treatment process will be.

Most people have good results from Achilles tendinitis surgery. The factor that affects your recovery is how much of your tendon has damage. People with a lot of tendon damage need a longer recovery time.

Physical therapy plays a big role in your rehabilitation, either as a treatment method or as part of your recovery from surgery. It can help you regain your strength and function.

How can I take care of myself if I have Achilles tendinitis?

Achilles tendinitis can be frustratingly slow to heal. It can take time for your symptoms to disappear completely. Follow your healthcare provider’s instructions so you don’t reinjure the tendon and worsen the symptoms.

If you’re trying nonsurgical treatments to avoid or delay surgery, expect to wait a few months to see improvement. To keep your tendon healthy:

• Attend physical therapy.
• Avoid certain activities or sports.
• Stretch your muscle.
• Wear supportive shoes.

If you’re recovering from surgery, follow your provider’s instructions for the recovery period:

• Attend physical therapy.
• Do range-of-motion exercises to keep your tendon moving.
• Wear your cast, splint or boot for the required period.

When should I see a healthcare provider about Achilles tendon pain?

Call your provider or go to an urgent care center if you have:

• Symptoms that don’t improve after a few weeks.
• Severe pain.
• Signs of a ruptured tendon (including if you heard a popping sound).

What else should I ask my healthcare provider about Achilles tendon pain?

If you have Achilles tendon pain or Achilles tendinitis, ask your provider:

• Do I have Achilles tendinitis?
• What can I do to keep it from getting worse?
• Do I have an Achilles tendon rupture?
• What nonsurgical treatments can I try?
• Will I need Achilles tendon surgery?
• Will physical therapy help me?
• How long will it take to recover from Achilles tendinitis?
• What activities should I avoid?
• What medications can help me feel better?

A note from Cleveland Clinic

Achilles tendon pain is common in athletes and active people. If you have Achilles tendon pain, talk to your healthcare provider. The longer you wait to take care of it, the longer it takes to treat. You can treat Achilles tendinitis using nonsurgical methods, such as avoiding certain activities, using custom orthotics and attending physical therapy. If nonsurgical treatments don’t provide relief, talk to your provider about surgery for Achilles tendinitis.