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  • Writer's pictureDr. Ndidi Ufondu, DPM

Achilles Tendonitis: Causes, Symptoms, and Treatments

The Achilles tendon is one of the largest and strongest tendons in the human body. It connects the muscles in the calf to the heel bone, enabling activities like walking, running, and jumping. Unfortunately, this crucial tendon is also vulnerable to injury and inflammation known as Achilles tendonitis.

As a podiatrist treating numerous patients managing Achilles pain and tears, I've seen how debilitating these issues become without proper care. Understanding the anatomy behind these injuries and applying consistent treatment helps get athletes safely back on their feet once more.

The Anatomy Behind Achilles Tendonitis

InjuryMap, CC BY-SA 4.0 <>, via Wikimedia Commons

The Achilles tendon forms a thick band approximately 15 cm long spanning from calf muscles down to the heel bone (calcaneus). Forces up to 12.5 times body weight can transmitted through this narrow structure during running or jumping.

With repetitive overloading, microtears and scar tissue develops weakening the tendon's structural integrity. Laterally angled traction exacerbates these tiny lesions into further tears and inflammation - Achilles tendonitis.

Common Causes and Risk Factors

Achilles tendonitis frequently stems from:


  • Excessive training volume, intensity, or low rest periods

  • Repeated eccentric contractions (e.g. hill running)

Poor flexibility

  • Tight calf muscles increase strain on Achilles tendon

Faulty biomechanics

  • Excessive foot pronation shifts lower leg alignment

  • High arched feet lack shock absorption

Improper footwear

  • Minimalist shoes suddenly increase strain on tendon

  • Worn shoes lose cushioning and support


  • Tendon elasticity naturally declines past 30 years old


  • Excess weight overloads the tendon


  • Impaired blood flow slows healing

With multiple factors frequently in play, Achilles tendonitis often develops gradually over time until suddenly quite painful. Receiving swift diagnosis and care minimizes how significantly injuries disrupt patients’ daily living and sports performance.

Recognizing Achilles Tendonitis Symptoms

Many patients first notice Achilles tendonitis symptoms after a recent training change - either in volume, intensity, or footwear. Ongoing mild soreness then progresses to more debilitating pain.

Key symptoms include:

  • Morning ankle stiffness improving with movement

  • Swelling and thickening of the tendon

  • Tenderness when squeezed

  • Limping from discomfort walking or running

  • Creaking sounds during ankle motions

I also assess for potential contributing biomechanical factors like overpronation, leg length discrepancies, or high foot arches.

While sharp Achilles pain often indicates ruptures, chronic achiness signals tendonitis. I combine a detailed history and physical exam to differentiate between diagnoses and severity.

Early intervention improves recovery outlook and prevents small irritations becoming complete tears or ruptures suddenly ending athletic seasons.

Podiatric Treatments for Achilles Tendonitis

Initial Achilles tendonitis management focuses on reducing swelling and pain to facilitate healing. I tailor evidence-based treatment plansutilizing:

Activity modification

  • Temporarily limiting aggravating athletic moves

  • Stretching, cross-training to maintain fitness

Immobilization bracing

  • Lightweight boots allowing tendon to rest

Physical therapy

  • Gradually strengthening surrounding musculature

  • Improving flexibility

Orthotic devices

  • Controlling overpronation decreasing repetitive strain

Footwear modifications

  • Cushioning, stability features distributing impact

Oral medications

  • Anti-inflammatories relieving swelling and pain


  • Platelet-rich-plasma to stimulate localized healing

Surgery is rarely indicated for tendonitis and only utilized for complete Achilles ruptures, or cases not responding to exhaustive conservative options over 6-12 months.

Consistency complying with rehabilitation protocols allows patients to regain normal functioning. I then advise transitioning back to full activity gradually to avoid re-injury.

Achilles Tendonitis Self-Care and Prevention

Alongside professional treatment, I educate patients on smart self-care strategies:

Rest days

  • Scheduling regular non-exercise recovery periods

  • Avoiding overtraining injury-prone fatigued tendons

Gradual build-up

  • Increasing training intensity, duration, distance slowly overweeks/months

Proper warm-ups/cool-downs

  • Easy cardiovascular activity increases blood flow before and after training

  • Gentle stretches enhance tissue pliability


  • Gentle cross-friction massage encourages healing blood flow into tendons

  • Avoid direct pressure over acutely inflamed regions

Heel lifts

  • Raising heels slightly redistributes calf tension when walking

  • Allows continued mobility despite Achilles discomfort

Supportive footwear

  • Shoes control excess foot motion related to injury

  • Replace regularly as cushioning wears down

A combination of professional and at-home care limits recurrence of Achilles irritation for most motivated athletes.

When to See a Podiatrist for Achilles Tendon Issues

Consult a podiatrist promptly if experiencing:

  • Persistent swelling, limping beyond 2 weeks

  • Hearing popping, tearing sounds from Achilles region

  • Worsening pain despite rest, over-the-counter anti-inflammatories

  • Lumps or nodules developing along injured tendon

Debilitating stiffness and throbbing pain often indicates advanced cases of tendonitis or partial tendon tears. Early podiatric assessment and care then prevents full ruptures suddenly ending athletic careers.

While active adults under 30 years old suffering isolated overuse injuries generally recover well, risks of recurrence and slower healing progress after 30 years old. My advanced interventions combine traditional protocols with regenerative medicine injections, customized bracing, and progressive reloading protocols.

Stay Active with Expert Achilles Injury Care

The Achilles tendon plays an integral role in most physical pursuits from elite athletics to basic mobility. Despite its fundamental functionality, capacity for wear-and-tear over time remains limited.

Combining smart training practices, appropriate footwear, and consistent professional treatment allows maintaining an active lifestyle long-term. As a sports medicine focused podiatrist, I offer dedicated care plans tailored to each patient’s demands and goals.

My expertise in linking biomechanical lower limb alignment to Achilles pathology informs effective prevention and rehabilitation. If tendon pain or stiffness starts hindering your normal activity, seek prompt podiatric consultation so customized care keeps you moving.

Key Takeaways

  • Achilles tendonitis is inflammation from repetitive overuse and strain

  • Recognize tendonitis early via swelling, creaking, morning limping

  • Podiatrists offer braces, medications, footwear modifications providing pain relief

  • Self-care like calf stretching, massage aids recovery between appointments

  • Don't delay with worsening Achilles pain which risks tendon rupture

  • Combining treatments and preventative training allows for enduring active lifestyles


Should I continue training with Achilles tendonitis?

Advanced Achilles tendonitis requires resting the injured area to allow healing, however maintaining cardiovascular fitness and muscle strength via swimming, cycling or upper body workouts is advised. Slowly resume normal training only after swelling subsides and pain-free movement restored.

Does insertional tendonitis differ from mid-portion?

Yes, insertional/enthesitis refers to inflammation where the Achilles tendon inserts into the heel bone while mid-portion tends to become irritated a few centimeters higher from calf muscle to the midpoint of the tendon.

How long does Achilles tendonitis take to heal?

With appropriate activity modification, anti-inflammatory care, and physical therapy, most cases of Achilles tendonitis improve within 3-6 months. Exact recovery periods vary based on severity at diagnosis and patient's compliance with treatment.

When should surgery be considered?

Surgery for chronic Achilles tendinitis recalcitrant to 6-12 months of dedicated conservative therapy may involve removing damaged tissue or calcifications, though outcomes remain inconsistent. Acute tendon ruptures are often repaired surgically to restore integrity and strength.


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