woman running with woods behind herAs a runner you know the importance of keeping your feet in top condition. You may be well aware of the most common cause of runner's foot pain, namely heel pain or plantar fasciitis. But another condition nearly as prevalent as heel pain in runners is Achilles tendon pain.

And this shouldn't be surprising. After all the term "Achilles heel" comes from the Greek tragedy, the Illiad. In this saga, Achilles leads the Greeks against the Trojans. A powerful warrior his only weakness is his Achilles. For today's runner this is also true. An Achilles rupture or tear can be a season ending event.

While an Achilles rupture can change the outcome of a game or race, it's by no means the most common form of Achilles tendon pain. Achilles tendonitis and it's cousin Achilles tendonosis are much more common.

What is the Achilles tendon?

The Achilles is the largest and strongest tendon in the body. It can withstand forces of up to 1000 pounds or more. It's located where the calf muscle joins the heel bone. The Achilles makes it possible for us to push off while we run, jump, or walk. Without it we would be incapable of movement. That's why when our Achilles tendon becomes inflamed or sustains an injury treatment is imperative.

Achilles Tendonitis

Achilles tendonitis is an inflammation of the Achilles tendon. It results from micro-tears that develop as a result of too heavy or sudden pressure on the tendon. These can occur as a result of running hills, rapidly increasing training time and distance, and sprinting.

Other risk factors

Other risk factors for Achilles tendonitis are:

  • Sex (men are more prone to it)
  • Increased age
  • Over pronation resulting from flat or low arches
  • Tight calf muscles
  • Wearing unsupportive or worn out running shoes
  • Medical conditions such as psoriasis and high blood pressure
  • Taking antibiotics called fluoroquinolones.

Two types of Achilles tendonitis

There are two types of Achilles tendonitis based on where the inflammation is located, insertional and non-insertional.


Insertional Achilles tendonitis occurs in the lower portion of the heel where the tendon inserts into the heel bone. This type of tendonitis tends to develop with years of overuse and is most commonly seen in marathoners and sprinters.


Non-insertional Achilles tendonitis occurs in the middle portion of the tendon and is more common in younger athletes.

Sign and Symptoms

  • Mild pain after running that gradually worsens.
  • Pain occurs most often after periods of rest and with first steps out of bed in the morning.
  • A dull or sharp pain along back of tendon.
  • Tenderness or sometimes intense pain can be experienced when the sides of the tendon are squeezed.


If you're experiencing any of the signs and symptoms of Achilles tendon pain it's important to stop running. Running through your pain will make the condition worse. Rest and sometimes immobilization in a walking boot are necessary to recover from Achilles tendonitis.

In addition, treatment at home or at your podiatry office often includes the following:

Reduce the inflammation

To assist in your recovery it's important to reduce the inflammation.

  • Use ice 20 minutes out of every hour.
  • Take nonsteroidal anti-inflammatory medication. Note: Consult your physician before taking any medication.
  • Receive MLS laser therapy for pain relief and reduction of inflammation

Improve your foot biomechanics

  • Orthotics can help support the muscle and relieve stress on the tendon. Over-the-counter shoe inserts or custom orthotics will both work depending on your foot type and the length and severity of the problem.

Stretch your calf muscles

Adequately stretching tight calf muscles is needed in the treatment and prevention of Achilles tendonitis. One of the best ways to do this is by using an Achilles splint 1-2 times/day for 20-30 minutes while watching TV or reading a book. Please watch this video on How to Use An Achilles Splint for Stretching Calf Muscles. Sports medicine physicians and others also recommend using a foam roller as an adjunct to stretching.

Get physical therapy

We recommend physical therapy for:

  • exercises to lengthen the Achilles tendon
  • strengthen the Achilles tendon
  • gait training


Surgery may be needed if the tendon does not recover using more conservative approaches.


It's far better to prevent Achilles tendonitis than to heal from it.

Achilles Tendonosis

Achilles tendonosis in runners is a degeneration of the collagen protein that forms the tendon. It's a response to chronic overuse without adequate time to heal and rest. When the tendon is damaged in this way, healing is haphazard and abnormal, resulting in pain when put under tension, stressed, or touched. This new tendon can be weaker, prone to re-injury and rupture if not adequately rehabilitated. The tendon will show up thicker on MRI.

Tendonitis can progress to tendonosis when treatment of the former condition has been insufficient. When the disorder progresses to degeneration, it can become enlarged and nodules can develop in the area where the tissue is damaged.

Signs and Symptoms

Runners with Achilles tendonosis will experience pain, tenderness, and stiffness without inflammation (swelling and redness) seen in Achilles tendonitis.

  • Tightness and loss of flexibility in the ankle.
  • Pain particularly after rest and upon wakening in the morning.
  • A nodule on the back of the heel
  • A jellylike consistency internally making the tendon soft and weak

Treatment and Prevention

Treatment and prevention are similar to those employed for Achilles tendonitis with special emphasis on curtailing all activities that put stress on the tendon. Immobilization will be required to ensure the tendon gets adequate healing time. Ice may be of limited value since there is typically no inflammation in this condition. MLS laser therapy has been shown to work well in healing old injuries by bringing more blood floor to the site. It could be of important value in healing Achilles tendonosis.

Achilles Tendon Rupture

An Achilles tendon rupture is a complete or partial tear that occurs when the tendon is stretched beyond its capacity. Sudden accelerations during running or a trip or fall can overstretch the tendon and cause a tear.

Achilles tendon ruptures are most often seen in "weekend warriors" – typically, middle-aged people participating in sports in their spare time. Less commonly, illness or medications, such as steroids or certain antibiotics, may weaken the tendon and contribute to ruptures.

Signs and Symptoms

While sometimes there are no signs and symptoms of Achilles tendon rupture the most common ones are:

  • Feeling of being kicked or stabbed in the calf or ankle
  • Popping or snapping sensation
  • Swelling in the back of the leg between the heel and calf
  • Difficulty walking and rising up on the toes

Risk Factors

Men are at greater risk for Achilles tendon rupture due to their lack of flexibility compared to women. Runners with a previous history of Achilles tendonosis are also at greater risk.


Most often Achilles tendon ruptures require surgery since the chance of re-rupture is great for those still planning to continue with their running career. For those who plan a more sedentary lifestyle or concerns about nerve damage or infection should choose a more conservative treatment route similar to those used to treat the other two Achilles tendon conditions.


In addition to following all the previous recommendations stated earlier, runners who've a history of Achilles tendonosis should take great care to moderate their level of activity and watch out for irregularities in their running surface.

Call us today at 206-368-7000 for an appointment. Often same day for emergencies and less than 2 weeks for chronic foot pain. You can also request an appointment online.

Seattle foot and ankle specialist, Dr. Rion Berg offers foot care for patients with bunions, heel pain, diabetes, fungal toenails, ingrown nails, and surgical solutions when needed to residents of Seattle, Bellevue, Kirkland, Shoreline, Lake Forest Park, Mountlake Terrace, Lynnwood and other surrounding suburbs.

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