What is Achilles tendonitis?
The Achilles tendon attaches your calf muscles to your heel bone, or
calcaneus. You use this tendon to jump, walk, run, and stand on the balls of
your feet. Continuous, intense physical activity, such as running and jumping,
can cause painful inflammation of the Achilles tendon, known as Achilles tendonitis
Simple home treatments can help Achilles tendonitis. However, if home
treatment doesn’t work, it’s important to see a doctor. If your tendonitis gets
worse, your tendon can tear. You may need medication or surgery to ease the
Causes of Achilles tendonitis
Excessive exercise or walking commonly causes Achilles tendonitis, especially
for athletes. However, factors unrelated to exercise may also contribute to your
risk. Rheumatoid arthritis and infection are both linked to tendonitis.
Any repeated activity that strains the Achilles tendon can potentially
cause tendonitis. Some causes include:
without a proper warmup
the calf muscles during repeated exercise or physical activity
sports, such as tennis, that require quick stops and changes of direction
old or poorly fitting shoes
high heels daily or for prolonged durations
Symptoms of Achilles
- discomfort or swelling in the back of your heel
- tight calf muscles
- limited range of motion when flexing the foot
- skin on your heel is overly warm to the touch
The main symptom of Achilles tendonitis is pain and swelling in the back
side of your heel when you walk or run. Other symptoms include tight calf
muscles and limited range of motion when you flex your foot. This condition can
also make the skin on your heel feel overly warm to the touch.
To diagnose Achilles tendonitis, your doctor will ask you a few
questions about the pain and swelling in your heel or calf. Your doctor may ask
you to stand on the balls of your feet while they observe your range of motion
and flexibility. The doctor also feels around (palpates) the area directly to
pinpoint where the pain and swelling are most severe.
Imaging tests may help confirm Achilles tendonitis, but you usually
don’t need them. If ordered, the tests include:
which provide images of foot and leg bones
scans, which can detect ruptures and tissue degeneration
which can show tendon movement, related damage, and inflammation
Treating Achilles tendonitis
Many treatments are available for Achilles tendonitis, ranging from
rest and ibuprofen (Advil) to steroid injections and surgery. Your doctor might
your physical activity
gentle stretching and later strengthening of the calf muscles
to a different, less strenuous sport
the area after exercise or when in pain
your foot to decrease any swelling
a brace or walking boot to prevent heel movement
to physical therapy
anti-inflammatory medication, such as aspirin or ibuprofen, for a limited
a shoe with a built-up heel to take tension off the Achilles tendon
The rest, ice, compression, and elevation (RICE) method is usually
effective in treating your Achilles tendonitis right after you’re injured. This
method works in the following way:
- Rest: Don’t put pressure or weight on your
tendon for one to two days until you can walk on the tendon without pain. The
tendon usually heals faster if no additional strain is placed on it during this
time. Your doctor may suggest that you use crutches if you need to go long
distances while resting your tendon.
- Ice: Put ice in a bag, wrap the bag in a cloth
material, and place the wrapped bag of ice against your skin. Hold the bag on
the tendon for 15 to 20 minutes, then take the bag off to let the tendon warm
up again. The ice usually makes inflammation or swelling go down faster.
- Compression: Place a bandage, athletic tape, or
tie an article of clothing around the tendon to compress the injury. This keeps
the tendon from swelling too much. But don’t wrap or tie anything too tightly
around the tendon, as it can limit blood flow.
- Elevation: Raise your foot above the level of
your chest. Because your foot is higher than your heart, blood returns to the
heart and keeps the swelling down. This is easiest to do by lying down and
putting your foot on a pillow or other raised surface.
In a case where this treatment isn’t effective, surgery may be
necessary to repair the Achilles tendon. If the condition worsens and is left
untreated, there’s a greater risk of an Achilles rupture, which requires a
surgical intervention. This can cause sharp pain in the heel area.
Your doctor may recommend a few options for a tendon rupture surgery
based on how severe your rupture is and on whether you’ve had a rupture before.
Your doctor may also refer you to an orthopedic surgeon to decide which
procedure is best for you.
One method is called open repair. In this surgery, a surgeon makes an
incision to open your leg above the heel bone. Then, they sew the two sides of
the ruptured tendon back together and close the incision.
In another method, a surgeon makes an incision to open the area on
your leg where the rupture happened. Then, they pass needles with sutures
through the tendon and the skin and back out through the incision. Finally,
they tie the sutures together.
Complications of Achilles tendonitis
The most common complication of Achilles tendonitis is pain, having
trouble walking or exercising, and your tendon or heel bone becoming deformed.
You can also experience a complete tear (rupture) of the Achilles tendon. In
this case, you’ll usually need surgery to fix the rupture.
One study found that
complications such as hematomata (blood swelling and clotting inside tissue)
and deep vein thrombosis (blood clot in a deep vein) are possible after a
surgery for Achilles tendonitis. Complications can worsen if you don’t follow
your doctor’s instructions after an operation. If you continue to put stress or
wear on your Achilles tendon after a surgery, your tendon can rupture again.
Recovery and outlook
Tendonitis usually goes away after a few days, following rest and
proper home treatment (including the RICE method). Recovery takes a lot longer
if you continue to put pressure on the tendon or don’t change your exercise
habits to prevent another injury or rupture. Chronic, long-term tendonitis can
cause worse issues, including insertional tendonitis (tendon inserting itself
into the heel bone) and tendinosis (weakening of the tendon).
A tendon rupture or chronic tendonitis may require long-term treatment
or surgery. Recovery from surgery can take anywhere from a few weeks to a few
months for full recovery. Seeking treatment for your tendonitis or ruptured
tendon right away and following your doctor’s instructions is more likely to
result in a quicker recovery.
Preventing Achilles tendonitis
To lower your risk of Achilles tendonitis, try to:
your calf muscles at the beginning of each day to improve your agility and
make your Achilles less prone to injury. Try to stretch before and after
workouts. To stretch your Achilles, stand with a straight leg, and lean
forward as you keep your heel on the ground.
into a new exercise routine, gradually intensifying your physical
high- and low-impact exercises, such as basketball with swimming, to
reduce constant stress on your tendons.
shoes with proper cushioning and arch support. Also make certain the heel
is slightly elevated to take tension off the Achilles tendon. If you’ve
worn a pair of shoes for a long time, consider replacing them or using
the heel size of shoes gradually when transitioning from high heels to
flats. This allows the tendon to slowly stretch and increase its range of