Achilles Tendonitis: Symptoms, Causes, and Treatment for Achilles Pain

The Achilles tendon is the band of tissue connecting the muscles in the back of your lower leg to your heel bone. It is one of the longest tendons in the body and you use it to push off the ground when walking or running. Achilles tendonitis—sometimes spelled Achilles tendinitis—is an injury that occurs when this band becomes inflamed or irritated, resulting in heel pain.

There are two types of Achilles tendonitis. Insertional Achilles tendonitis is diagnosed when the inflammation occurs where the tendon attaches to the heel bone. In non-insertional Achilles tendonitis, the irritation is more in the middle of the tendon.

Causes of Achilles Tendonitis

There are many potential causes of Achilles heel pain and irritation. Often, Achilles tendonitis is linked to overuse, or to issues with technique or form in exercise. Tendonitis is most often a chronic injury (damage occurs over time, not in a sudden incident such as a fall or a rupture of the tendon).

• Overtraining: When you place a large amount of stress on your Achilles tendon, it can become inflamed from tiny tears that occur during physical activity. Achilles tendonitis is often a result of overtraining or doing too much too soon. Excessive hill running can contribute as well.
• Changing exercise routine: As you get more fit, it's normal to increase exercise intensity and duration. If you make these increases too fast, without allowing the body to adjust, you may notice a sore Achilles tendon.
• Calf muscle tightness: A tight calf is another potential cause of Achilles tendon pain. Many of today's best calf-stretching devices can help keep your muscles lengthened and relaxed. Research has connected chronic Achilles tendon issues with weak calf muscles as well.
• Wearing different shoes: Changes in footwear, such as switching to a minimalist shoe, can aggravate the Achilles tendon and cause heel pain.
• Modifying running technique: Changing running style by transitioning to a forefoot strike pattern and running on the balls of your feet can also contribute to Achilles tendonitis risk.
• Flat feet: Flattening of the arch of your foot can place you at an increased risk of developing Achilles tendonitis because of the extra stress placed on your Achilles tendon when walking or running.
• Overpronation: If your foot rolls inward when you walk or run, this could increase your risk of injuring the Achilles tendon. Studies suggest that this is because it disrupts blood flow along the tendon.
• Being overweight: Having a higher body mass index (BMI) is another risk factor. However, studies show people who have a BMI over 25 are just as likely as others to succeed in treating Achilles tendonitis with conservative measures.

Symptoms

The signs and symptoms of Achilles tendonitis often develop gradually. They can include:

• Heel pain and stiffness. It's common to experience pain and stiffness in the back of your ankle, especially when you first get out of bed or after sitting for a long period of time. This pain sometimes lessens with warm-up run and may even disappear as you continue running. But once you stop, the pain often returns and may feel even worse.
• Swelling that worsens throughout the day. There may also be mild swelling or a small bump on your Achilles tendon. Depending on how long you've been experiencing these symptoms, you may or may not experience swelling.
• Achilles band thickening. You might notice a thickening of your Achilles tendon, which is known as Achilles tendinopathy. 
• Bone spur. If you have a bone spur, you might also have insertional Achilles tendonitis.

Diagnosis

Diagnosing Achilles tendonitis generally begins with a physical examination of your foot and ankle area. This involves looking for some of the symptoms of this condition, such as swelling, Achilles band thickening, and the presence of bone spurs.

If Achilles tendonitis is suspected, your doctor may request further testing to know for sure. Ultrasounds, x-rays, and magnetic resonance imaging (MRI) tests can all help identify whether this condition exists and, if so, determine the extent of the tendon damage.

Achilles Tendonitis Treatment

You may be able to treat Achilles tendonitis on your own, at home. If home treatments are not effective, seek treatment from your physician.

At-Home Tendonitis Treatment

There are a few things you can do at home to begin easing the heel pain that occurs with Achilles tendonitis. One of the simplest is to use the R.I.C.E. method.

• Rest. Take a few days off from exercise, but make sure you move the injured ankle through its full range of motion and perform gentle calf and ankle stretches to maintain flexibility. Avoid physical activities that make your heel pain worse. Do low-impact exercises or cross-training to stay fit while the Achilles heals.
• Ice. Ice the Achilles for up to 20 minutes at a time, as needed, to help reduce swelling and heel pain.
• Compression. Wrap the Achilles to compress the area. Elastic wraps or ankle compression socks or sleeves may help in the short term.
• Elevation. When possible, lie down with your foot raised above heart level.

If the pain is bothersome, over-the-counter pain relievers may provide some relief. Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can increase your risk of heart attack, stroke, ulcers, and holes in the digestive tract. Talk to your doctor to determine if these medicines are safe for you to take.

Using foot orthotics may help as well. Research shows that placing a heel lift in your shoe can reduce the load placed on the Achilles tendon.

Physical Therapy and Surgery

If self-care doesn't work, it's important to get the injury treated by a healthcare professional. If the tendon continues to sustain small tears through movement, it can rupture.

Depending on the extent of the damage, your doctor may suggest physical therapy. Physical therapy can help the tendon heal and repair itself over a period of several weeks.

For more severe cases of Achilles heel pain, extracorporeal shockwave therapy or even surgery may be recommended. Surgical procedures can elongate calf muscles, remove heel spurs or damaged areas of the tendon, or repair tendon damage.

Prevention

Strengthening the soft tissue in the lower leg can help reduce injury risk to this area by making it more able to withstand physical exercise and movements. This includes:

• Strengthening the Achilles tendon
• Strengthening the calf muscles
• Strengthening the intrinsic foot muscles (especially if you wear a minimalist shoe)

When running, be especially careful that you don't overdo it, such as when introducing speed training or hill training into your regimen. And don't do a hard workout two days in a row. Those just starting a regular exercise regime may benefit from wearing running shoes for beginners.

Also, work low-impact cross-training activities, such as cycling and swimming, into your training. This enables you to stay fit while reducing the load on the Achilles tendon. A proper warm-up before these workouts can further prevent Achilles injuries.