Achilles tendinitis is inflammation of the Achilles tendon. It typically occurs due to overuse injuries and will resolve with rest. However, severe cases may require medical intervention.

The Achilles tendon joins the calf muscles to the heel bone and runs down the back of the lower leg. Achilles tendinitis, or tendonitis, typically results from microtears in the tendon during strenuous, high impact exercise.

Untreated, the tendon can become torn or ruptured. In mild cases, treatment may involve resting or changing an exercise routine, but in more severe cases, it may require surgery.

Person running, set against a sunriseShare on Pinterest
Tunvarat Pruksachat/Getty Images

Treatment aims to relieve pain and reduce swelling. The choice of treatment will depend on the severity of the condition.

Methods of treating Achilles tendinitis include:

  • Ice packs: Applying these to the tendon when in pain or after exercising can alleviate pain and inflammation.
  • Rest: This gives the tissue time to heal. The type of rest needed depends on the severity of the symptoms.
  • Elevating the foot: Keeping the foot raised above the level of the heart can reduce swelling.
  • Pain relief: Nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, can reduce pain and swelling.
  • Steroid injections: Steroid injections may reduce swelling in the targeted area.
  • Compression bandages and orthotic devices: Ankle supports and shoe inserts can aid recovery by taking the stress off the tendon.
  • Extracorporeal shockwave therapy (ESWT): This treatment aims to stimulate natural repair processes through high-energy shockwaves.
  • Platelet-rich plasma (PRP) therapy: PRP therapy involves injecting platelet-rich blood into a target area to promote healing. Further research is needed to assess its efficacy in treating tendinopathy.

Mild cases of tendinitis may heal within 2 to 3 weeks. Severe cases may require further intervention and take longer to heal.

Surgery

Surgery can repair the damage sustained by the tendon as a result of Achilles tendinitis. The American Academy of Orthopedic Surgeons (AAOS) only recommends surgery if the pain continues for 6 months or more.

The most common procedure is gastrocnemius recession. This involves lengthening one of the two muscles that make up the calf, to give the ankle a wider range of motion.

Achilles tendinitis cannot be prevented entirely, but a person can reduce their risk of tendinitis by being aware of the possible causes and taking precautions.

These include:

  • Varying exercise: Alternating between high-impact exercises, such as running, and low-impact exercise, for example, swimming, can reduce stress on the Achilles tendon on some days.
  • Limiting strenuous impacts: Too much hill running, for example, can put excessive strain on the Achilles tendon.
  • Wearing the correct shoes and replacing them when worn: Shoes that support the arch and protect the heel create less tension in the tendon.
  • Using arch supports inside the shoe: This can help if the shoe is in good condition but does not provide the required arch support.

It is important to stretch and warm up before and after exercising. Stretching helps to keep the Achilles tendon flexible, so there is less chance of tendinitis developing. Stretching every day, including rest days, will further improve flexibility.

A physical therapist can teach stretching exercises to improve flexibility and increase calf strength.

Here are two exercises, suggested by the AAOS.

Calf stretch

  1. Lean forward with your hands against a wall.
  2. Have one foot on the ground, with the leg straight, and one foot in front of it, with the knee bent.
  3. Push your hips toward the wall and hold for 10 seconds.
  4. Relax and repeat 20 times for each foot.

Bilateral heel drop

  1. Stand with the front half of your foot on the stair and the heel off, holding a rail to make sure you are balanced and will not fall.
  2. Slowly lift your heels and lower them as far as you can.
  3. Repeat 20 times.

Both exercises must be done slowly and in a controlled manner. Doing them fast can increase the damage.

This may help the Achilles tendon to heal and prevent future injury. Physical therapy is normally more effective for noninsertional Achilles tendinitis.

The main symptom of Achilles tendinitis is a gradual buildup of pain. The individual may also notice the following:

  • The Achilles tendon feels sore a few centimeters above where it meets the heel bone.
  • The lower leg feels stiff, slow, or weak.
  • A slight pain appears in the back of the leg after running or exercising and becomes more severe.
  • Pain in the Achilles tendon occurs while running or a couple of hours after.
  • Pain is greater when running fast, for a long time, or when climbing stairs.
  • The Achilles tendon swells or forms a bump.
  • The Achilles tendon creaks when touched or moved

These and other similar symptoms feature in a number of conditions, so medical advice is needed for an accurate diagnosis.

A doctor will ask about symptoms and perform a physical examination. They will lightly touch the back of the ankle and tendon to locate the source of the pain or inflammation.

The doctor will also test the foot and ankle to see if the range of motion and flexibility is impaired.

An imaging test, such as an X-ray, MRI, or ultrasound scan, can help eliminate other possible causes of pain and swelling and assess any damage to the tendon.

Achilles tendinitis is the swelling of the Achilles tendon following an injury. Common causes include over-exertion from running and other activities.

Mild cases typically resolve within 2 to 3 weeks, and people can typically treat these with rest and painkillers if necessary. more severe cases may require medical intervention and will take longer to heal.