Achilles tendonitis is an overuse injury causing pain at the back of the ankle. If not caught early, it can be a difficult injury to cure.
Achilles tendonitis symptoms & diagnosis
Achilles tendonitis is either acute or chronic. Acute Achilles tendonitis symptoms develop over a few days and become chronic if not treated correctly.
- Pain and stiffness in the Achilles tendon.
- Pain is worse first thing in the mornings, or after a period of rest.
- Symptoms decrease as your tendon warms up, only to return later.
- Pressing in or squeezing from the sides feels tender.
- You may feel a nodule or lump in the middle of the tendon.
- Pain develps over a period of weeks or even months.
- Symptoms become worse during exercise.
- Walking, especially uphill or upstairs is painful.
- Chronic Achilles pain does not necessarily prevent activity. However, it niggles away, affecting performance.
In the long-term, this may lead to a total Achilles rupture.
How bad is my Achilles tendonitis?
The VISA Achilles tendon pain questionnaire (download PDF) how severe your injury is. Simply answer a few questions to get a score out of 100. This is a good way of measuring progress.
What is Achilles tendonitis?
Achilles tendonitis, Achilles tendinopathy or Achilles tendinosis is an overuse injury resulting in pain, inflammation or degeneration of the Achilles tendon.
The Achilles tendon is the large thick band of tissue at the back of the ankle. It connects the calf muscles to the back of the heel. Huge forces go through the tendon when walking and running.
Tendonitis or tendinopathy?
Tendonitis suggests inflammation of the tendon (‘itis’ means inflammation). But in reality, few injuries are actually down to pure inflammation.
The main finding, particularly in older athletes is tendon degeneration. In other worse, wear and tear. The term tendinopathy is probably a better term to describe the range of conditions that can cause Achilles pain. Studies show that acute inflammatory cells are not usually present in long term, chronic injuries.
Tenosynovitis is another achilles injury which has similar symptoms. This is inflammation of the sheath surrounding the Achilles tendon.
Overuse is the primary cause. However, a number of factors increase your risk of injury.
Poor foot biomechanics
Overpronation is when your foot rolls in too much (flattens). As your foot flattens, your lower leg rotates and as a result, your Achilles tendon twists. This makes it more susceptible to overuse injury.
Make sure you choose the right running shoes for your foot type and the sport. A worn-out shoe or one that does not provide enough support can increase the strain on your Achilles tendon.
Wearing high heels
If you wear high heels regularly, this causes your Achilles tendon to adaptively shorten over time. Then, each time you wear your flat running shoes your tendon is being asked to repeatedly overstretch.
Avoid overtraining, increase your weekly running mileage gradually and by no more than 10% per week.
Running on soft surfaces, or sand is not great, because it allows your heel to sink. As a result, the Achilles tendon stretches further.
If you regularly run uphill or on a treadmill set at an incline, your Achilles tendon is continually overstretching. This again increases the risk of injury.
Achilles tendonitis treatment
Treatment for acute injuries includes rest and application of ice or cold therapy to reduce pain and inflammation. More chronic injuries often respond better to heat.
A strict 12-week heel drop exercise program is effective in chronic, stubborn cases.
Apply ice/cold therapy
For an acute injury applying ice for 10 minutes every hour or so for the first 2 to 3 days. Reduce frequency as your symptoms improve.
This may mean complete rest, or simply modifying your training activities.
Your doctor may prescribe anti-inflammatory medication. For instance, ibuprofen helps acute inflammation. However, not chronic injuries. In which case it may even inhibit healing long-term.
Application of Electrotherapy, such as ultrasound reduces pain and inflammation.
Heel lift/heel pad
This helps reduce strain on your Achilles tendon by temporarily shortening the calf muscle.
Wear in both shoes, not just the bad leg. Also, use only for a few days to avoid adaptive shortening of your tendon.
A simple Achilles tendon taping technique takes the strain off a painful tendon, allowing it to rest more easily, especially if you have to be on your feet.
Long-term chronic injuries may respond better to the application of heat. Apply for 10 minutes every couple of hours as required.
A night splint or sock is a good product for Achilles tendonitis. It is more commonly known as a Plantar fasciitis night splint and improves calf muscle flexibility, preventing them tightening up overnight.
Massage helps mobilize the tissues of the tendon and relax the calf muscles.
Sports physiotherapist Neal Reynolds explains Achilles tendonitis treatment:
Achilles tendonitis exercises
Studies show the Hakan Alfredson’s heel drop protocol exercises to be effective in up to 90% of patients suffering from Achilles tendon pain. You do 90 repetitions, twice a day of heel drop exercises, continued for 12 weeks.
Read more on Achilles tendon heel drop exercises.
Gentle calf stretching exercises can help stretch the muscles and aid recovery.
- Robinson JM, Cook JL, Purdam C et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. BJSM 2001;35(5):335-41
- Alfredson H, Lorentzon R. Chronic Achilles Tendinosis – recommendations for treatment and prevention. Sports Med 2000;29(2):135-46
- Alfredson H, Piettila T., Jonsson P et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine 1998;26(3):360-6