Achilles Tendonitis


Understanding Achilles Tendonitis

Achilles tendonitis is a common injury associated with the presence of inflammation and scar tissue in the largest tendon in the body. The Achilles tendon is located above the ankle in the back of the lower leg. It connects the large calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Its main function is to transfer power to the ankle during the push-off phase of the gait cycle while either walking and running.

Achilles tendonitis is commonly described in medical literature as “Achilles tendinopathy.” The presence of scar tissue and degenerative changes in the tissue often accompanies inflammation. Athletes older than 30 years of age with Achilles tendonitis often present with decreased elasticity and fiber strength in the tendon.

Achilles tendonitis is either of an acute variety, occurring over only a few days, or chronic, spanning a longer period of time.

With this condition, inflamed tissue is located anywhere along the tendon from the calf muscle or where it attaches to the heel, or calcaneus, bone. The healing period is often lengthy due to daily stress placed on the area when walking and performing normal activities, alongside a less-than-adequate blood supply.

The calf muscles described above merge together to form the Achilles tendon before it anchors or inserts into the calcaneus. The gastrocnemius is the larger and more superficial muscle, originating above the knee. Conversely, the deeper, shorter soleus does not cross over the knee joint.

Therefore, both calf muscles must be involved to obtain long-term pain control in Achilles heel pain treatment.


Signs & Symptoms of Achilles Tendon Pain

  • With milder cases of Achilles heel pain, localized pain that presents at the onset of exercise will decrease as the athlete warms up.
  • Pain and symptom onset can occur either quickly (within minutes) or build up gradually over days or weeks.
  • Symptoms such as pain, stiffness and calf weakness typically decrease with rest.
  • Tenderness may be noted anywhere along the tendon with palpation and during activities.
  • Prolonged periods of inactivity such as in the morning or after sitting for a long span of time can result in significant Achilles tendon pain and stiffness.
  • Palpable knots or lumps in the Achilles tendon are common.
  • Tendon “squeaking” is sometimes experienced with ankle motion.
  • Performing a one-legged toe raise with a completely straight knee may summon pain in the tendon, weakness in the calf and a limited range of motion in the ankle.
  • Swelling or thickening within the tendinous sheath is common.


Causes of Achilles Heel Pain

Achilles tendonitis is typically an overuse injury. The basic cause of these ailments is “doing too much too soon.” With that said, other factors can contribute to inflammation in the largest tendon in the human body:

  • Altered or improper footwear worn in physical activity or work environments
  • Inconsistency in training surface firmness and inclines, such as hills
  • A rapid increase in activity volume and/or intensity
  • Insufficient recovery time between workouts
  • Various arch and foot pathologies such as fallen arches, excessive pronation, hyper-supination or poor toe alignment
  • Weak calf muscles
  • Tight calves and Achilles tendons
  • Stiff ankles due to arthritic changes


Professional Treatment for Achilles Tendon Pain

  • Avoid activities and footwear, two classic factors, that are linked to symptoms.
  • Place a ¼ – ½ inch heel lift in both shoes when walking more than 50 yards.
  • Avoid prolonged barefoot walking.
  • Massage the calves, arches and front of ankles to promote a decrease in Achilles tendon and ankle stress with motion.
  • Improve arch and toe flexor strength with activities such as marble or rock pickups and towel curls in a seated position.
  • Perform daily calf rolling treatments for the calf and peroneal tendons (lower outside of the shin), but not on the Achilles tendon itself, to promote healing. Increase efficacy by warming up the tissue prior to treatment, and while slowly rolling the areas noted above, breath comfortably while consistently moving the foot in a wide circular pattern.
  • When at least 75% of the pain is gone when walking, initiate toe raises to strengthen the calf muscles. Start with double legs on a flat surface and progress to single legs on an uphill incline. Between strengthening sets, perform a 20-second “duck walk,” a straight-legged heel walking technique with the front of the foot off the ground. This (crazy looking) exercise is an effective drill to both enhance strength in the front of the ankle and prolong stretching of the Achilles tendon and calf.
  • Stretch both calf muscles to reduce Achilles tendon pain on a long-term basis. Perform wall pushes or slant-board stretches with both straight and bent legs to address both muscles and the Achilles tendon. Key Tip – Adjust the angle of your foot to keep the stretch pain-free while performing five slow breaths to promote relaxed tissue elongation.
  • Utilize calf compression during activities to maintain warmth and improve blood flow.
  • Ice your Achilles tendon and calf muscles in a moderately stretched position using ice bags/frozen veggies, an ice cup or (ideally) an ice bucket.


Questions a Pro Athlete Would Ask

Smart professional athletes with Achilles tendonitis who want to safely return to their sport will ask their sports medicine specialist the following questions:

1. What are the main factors causing my Achilles tendon pain?

2. Do I have abnormal foot/arch/subtalar joint biomechanics that must be addressed with an orthotic device?

3. Do I have a leg length difference of greater than 1/4 inch?

4. Am I a candidate for cross-friction massage on my Achilles tendon, or is that form of treatment too aggressive?

5. Who is the best physical therapist in the area to rehab with for my Achilles heel pain?


Elite Sports Medicine Tips


  • Look Around – Achilles tendon pain is likely related to a bigger issue than just isolated inflammation in your tendon. Examine everything from your shoulder levels, to your core strength, to your ugly toes for clues.
  • Break Out Your Magnifying Glass – What triggered this flare up right now, detective? List all activities and new routines from the past month – you may find the reason(s) staring right back at you!
  • Embrace Your Inner Gumby – I watch my young son stretch and bend every day like Stretch Armstrong. Unless you’re a former (or current) gymnast, flexibility generally wanes at our more mature age. Perform exercises every day to stretch your shoulder, back and legs.
  • Do Some Sole Searching – Compare the wear pattern on your favorite shoes. Do the soles look different from one side to the other?
  • DON’T Run for the Hills – Upon a return to activity, avoid hills for the first couple of weeks. Whether running, walking or biking, hills exert excess stress on the calves and Achilles tendon.