Achilles Tendinitis (Achilles Tendinopathy)
Also known as: Achilles tendinopathy, Achilles tendonitis, Achilles tendon inflammation, Insertional Achilles tendinopathy, Mid-portion Achilles tendinopathy
Last updated: December 18, 2024
Achilles tendinitis, more accurately termed Achilles tendinopathy, involves pain and dysfunction of the Achilles tendon connecting the calf muscles to the heel bone. It may be insertional (at the heel attachment) or non-insertional (mid-portion) and typically relates to overuse or degenerative changes. Pain along the back of the heel or above it often worsens with activity such as running or stairs, and morning stiffness may improve with movement. Most cases improve with conservative treatment, though recovery may be prolonged.
Key Facts
- •Achilles tendinitis, more accurately termed Achilles tendinopathy, is a condition involving pain and dysfunction of the Achilles tendon, which connects the calf muscles to the heel bone
- •Pain along the back of the heel or above it
- •Diagnosed through history, physical exam, and imaging
- •First-line treatment includes exercise, weight management, and activity modification
What It Is
Achilles tendinitis, more accurately termed Achilles tendinopathy, is a condition involving pain and dysfunction of the Achilles tendon, which connects the calf muscles to the heel bone. The condition may be insertional (at the heel attachment) or non-insertional (in the mid-portion of the tendon) and typically results from overuse or degenerative changes in the tendon.
Affected Anatomy
This condition affects several structures in and around the joint:
- •Achilles tendon (largest tendon in the body)
- •Calcaneus (heel bone) at the tendon insertion
- •Gastrocnemius and soleus muscles
- •Retrocalcaneal bursa
- •Paratenon (tissue surrounding the tendon)
- •Plantaris tendon (when present)
Common Symptoms
Symptoms can vary in intensity and may change over time. Common experiences include:
- •Pain along the back of the heel or above it
- •Pain that worsens with activity, especially running or climbing stairs
- •Morning stiffness in the Achilles tendon that improves with movement
- •Swelling or thickening of the tendon
- •Tenderness when pressing on the tendon
- •Pain after prolonged rest that improves with mild activity
- •Warmth over the affected area
- •Decreased strength or endurance in the calf
Causes and Risk Factors
Multiple factors can contribute to the development of this condition:
Causes
- •Overuse from repetitive stress, particularly running or jumping activities
- •Sudden increase in intensity, duration, or frequency of exercise
- •Tight or weak calf muscles
- •Degenerative changes in the tendon with aging
- •Improper footwear or training on uneven surfaces
- •Biomechanical factors such as flat feet or overpronation
Risk Factors
- •Middle age (most common in recreational athletes aged 30-50)
- •Running or jumping sports
- •Sudden increase in training load
- •Tight calf muscles or limited ankle dorsiflexion
- •Obesity
- •Flat feet or other foot abnormalities
- •Certain medications (fluoroquinolone antibiotics, corticosteroids)
- •Medical conditions including diabetes, hypertension, or psoriasis
How It's Diagnosed
Diagnosis typically involves a combination of clinical assessment and imaging studies:
- •Medical history focusing on activity patterns and symptom characteristics
- •Physical examination including palpation, range of motion, and strength testing
- •Assessment of calf flexibility and foot alignment
- •Thompson test to rule out complete rupture
- •X-rays may show calcification at the insertion or bone spurs
- •Ultrasound can visualize tendon thickening, tears, and increased vascularity
- •MRI provides detailed evaluation of tendon structure if diagnosis is unclear
Treatment Options
Treatment approaches range from conservative measures to surgical interventions, often starting with the least invasive options:
Self-Care and Activity Modification
- •Rest and activity modification to reduce aggravating activities
- •Ice application to reduce pain and inflammation
- •Heel lifts or orthotic devices may reduce tendon strain
- •Night splints to maintain tendon length
- •Extracorporeal shockwave therapy may be considered for chronic cases
Physical Therapy and Exercise
- •Eccentric strengthening exercises (heel drops) are a cornerstone of treatment
- •Physical therapy for stretching, strengthening, and biomechanical correction
Medications
- •NSAIDs for short-term pain relief
Surgery
- •Surgical treatment (debridement, repair) may be considered for refractory cases
Prognosis and Recovery
The course of this condition varies between individuals:
- •Most cases improve with conservative treatment, though recovery may be prolonged
- •Consistent adherence to eccentric exercise programs improves outcomes
- •Recovery often requires 3 to 6 months or longer
- •Insertional tendinopathy may be more resistant to treatment than non-insertional
- •Without treatment, chronic pain and tendon weakening may progress
Related Pages
- Ankle Sprain(Condition)
- Ankle Arthroscopy(Procedure)