Achilles Tendinitis

Tendons connect muscle to bone and often connect near a joint. Tendinopathy is an injury to the tendon. It can cause pain and swelling and makes it difficult to move. Tendinopathy may be:

  • Tendinitis—inflammation of the tendon
  • Tendinosis—tiny tears in the tendon with no significant inflammation


The Achilles tendon connects the calf muscle to the heel bone. Achilles tendinopathy is a pain in this tendon.

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Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes internal structural change. Overuse of the Achilles tendon can occur with activities such as:

  • Increasing speed or running long distances too quickly
  • Suddenly adding strenuous hills or stair climbing to an exercise routine
  • Doing too much, too soon after taking time away from exercising
  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • Running too much
  • Lack of flexibility of the calf muscles

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Factors that may increase the risk of having Achilles tendinopathy include:

  • Improper or badly-worn footwear
  • Inflexibility of the calf muscles
  • An improper training program—such as increasing intensity too quickly
  • Increased age—normal wear and tear can make the tendon more likely to become injured

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Symptoms of tendinopathy may include:

  • Tenderness—usually just above the heel bone and often more noticeable in the morning
  • Stiffness that gradually eases as the tendon is warmed-up
  • Pain that gradually worsens after activity
  • Pain along the tendon during and/or after running
  • Swelling in the area of the Achilles tendon
  • Pain at the back of the ankle

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The physician will ask about symptoms and exercise habits. A physical exam will be done and a diagnosis will be made based on the exam and history. Images of the bones and tendons may be taken with:

  • X-rays
  • Ultrasound
  • MRI scan


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Physical therapy intervention is an important part of treatment for Achilles Tendinitis.  Tendinopathy and the associated pain may take months to resolve. It can be frustrating, but it is important to follow through with the advised treatment.   Rest and ice are the first steps. It’s important to take a break from any activity that causes pain. A physical therapist will practice the RICE principles: Rest, Ice, Compression and Elevation, as well as give activities that do not put stress on the tendon.   Depending upon the severity of the injury, physical therapy may also include:

  • Stretching
  • Massage
  • Ultrasound
  • Custom orthotics
  • Strengthening exercises that focus on the calf muscles
  • Balance activities

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To decrease the chances of having Achilles tendinitis:

  • Wear appropriate footwear for your sport.
  • Do not use shoes beyond the advised duration. This will depend on:
  • How frequently you exercise
  • The surface on which you exercise
  • The conditions in which you exercise
  • Gradually add hill work, stairs, speed, and distance to your routine.

Stretch and strengthen the calf muscles regularly.

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  • American College of Sports Medicine

  • – American Academy of Orthopaedic Surgeons

  • Canadian Orthopaedic Association

  • Canadian Orthopaedic Foundation

  • Achilles tendinopathy. EBSCO DynaMed website. Available at: Updated July 9, 2013. Accessed February 28, 2014.
  • Achilles tendinitis. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: Updated June 2010. Accessed February 28, 2014.
  • Common disorders of the achilles tendon. American College of Foot and Ankle Surgeons Foot Health Facts website. Available at: Accessed February 28, 2014.
  • de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026-1028.
  • Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933-939.
  • 10/26/2010 DynaMed’s Systematic Literature Surveillance Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010 (6):CD007402.

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