The largest tendon in the body can be a source of intense pain in the back of the heel. Achilles tendinopathy is a common overuse injury, affecting people of all ages, both athletes and non-athletes.
What causes Achilles tendinopathy?
Short of an arrow to the back of the heel, Achilles tendinopathy is caused by repetitive or intense strain on the Achilles tendon.
You may be at increased risk of developing Achilles tendinopathy when you:
Do the same activities or exercises (such as jumping) over and over
Run at too high an intensity
Increase running distance too soon
Wear old or poor quality footwear
Start up too quickly after not exercising
Have weak calf muscles
Roll in (overpronation) of feet when running
Wear high heels, which shorten the tendon and calf muscles
What are the symptoms?
Common symptoms of Achilles tendinopathy include:
Pain. Pain is felt above the heel or back of the lower leg. Initially, it may be present only in the morning, during warming up, or after activity. In later stages, the pain may be more constant. Sudden, severe pain or trouble putting weight on the foot may suggest an Achilles tendon tear.
Morning stiffness. Stiffness around the tendon after getting up in the morning may ease after a few minutes of walking, but sometimes, it may last longer.
Tenderness. Tendon can be very tender to the touch, even with a gentle squeeze.
How is Achilles tendinopathy diagnosed?
Typically, the diagnosis can be made based on symptoms and a physical exam. An x-ray may be ordered to check for other conditions that can cause similar symptoms. An ultrasound or MRI may be ordered to assess for Achilles tendon tears or rupture.
What’s the treatment?
Achilles tendinopathy usually gets better on its own with self care. It can take months to heal.
To assist healing, self care measures include:
Rest. Rest the Achilles tendon and avoiding activities that causes pain
Chill it. Use a cold gel pack, or thin towel with ice on the injured area every 1 to 2 hours (for up to 6 hours), for 15 minutes each time for pain after activity.
Wrap it. Stabilize the ankle with an elastic bandage or wrap to keep the tendon from moving too much. A doctor or therapist should demonstrate proper ankle wrap techniques before self attempts.
Pain meds. Take pain relievers as directed or prescribed for pain
Strengthen it. Exercise to make calf muscles stronger and more flexible
Get help. See a physical therapist for exercise instructions and orthotic devices
Symptoms that do not get better after several months and tendon ruptures are usually treated with surgery.
I never want to get Achilles tendinopathy (again)
To lower the chance of getting Achilles tendinopathy:
Stretch. Warm up your muscles before exercising. Take time to stretch your calf muscles and Achilles tendon.
Take it easy. Avoid sudden increases in your exercise or activity.
Choose your shoes carefully. Wear the correct sneakers or shoes for your activity. Replace worn-out sneakers or shoes.
Stay warm. Wear warm clothes when running or exercising in cold weather.
Switch it up. Alternate high impact activities such as running, with low impact activities such as swimming.
Longo UG, Ronga M, Maffulli N. Achilles Tendinopathy. Sports Med Arthrosc Rev. 2018 Mar;26(1):16-30.
Maffulli N, Longo UG, Kadakia A, Spiezia F. Achilles tendinopathy. Foot Ankle Surg. 2020 Apr;26(3):240-249.