Some holding painful back of footThe Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. It's also called the heel cord and helps us walk by raising the heel off the ground.

Achilles tendonitis is an inflammation of the Achilles tendon. It typically resolves with proper conservative treatment over a short period of time. However, if the Achilles tendon ruptures it will require surgery which will take much longer to heal.  Both professional and weekend athletes may suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.

Causes

Achilles tendonitis is considered an overuse injury, making runners and other athletes more prone to acquiring it. Some specific situations that can put a person at risk for Achilles tendonitis are:

  • Hill running or stair climbing
  • Rapidly increasing mileage or speed when walking, jogging, or running.
  • Starting up too quickly after a layoff in exercise or sports activity, without adequately stretching and warming up the foot.
  • Trauma caused by sudden and/or hard contraction of the calf muscles when putting out extra effort, such as in a sprint.
  • Improper footwear
  • Faulty foot structure such as flat feet with a tendency toward overpronation.
  • Tight calf muscles

Two types of Achilles tendonitis

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

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

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

Symptoms

Achilles tendonitis often begins with mild pain after exercise or running that gradually worsens. Other symptoms include:

  • Aching, stiffness, soreness or tenderness. It can occur where the Achilles attaches above the heel to the region just below the calf muscle.Pain and these symptoms occur most often upon waking and periods of rest and lessen with movement.
  • Tenderness, or sometimes intense pain can be experienced when the side of the tendon are squeezed.
  • When the disorder progresses to degeneration, it can become enlarged and nodules can develop in the area where the tissue is damaged.

Treatment

  • Orthotics, which are corrective shoe inserts designed to help support the muscle and relieve stress on the tendon. Over-the-counter shoe inserts may be recommended instead for milder pronation and less severe cases. 
  • Immobilzation which can include a walking boot
  • MLS laser therapy for pain relief and reduction of inflammation
  • PRP (Platelet-Rish Plasma) for treatment of chronic Achilles tendonitis.
  • Taking nonsteroidal anti-inflammatory medication for a period of time. Note: Please consult your physician before taking any medication.
  • Physical therapy to include strengthening exercises, soft-tissue massage/mobilization, gait and running education, stretching for tight Achilles and calf muscles, and use of ultrasound.
  • Surgery may be needed if the tendon does not recover using more conservative approaches.

Achilles Tendonitis Pain in Runners

Learn about how to stop Achilles Tendonitis pain if you're a runner.

Preventing Reoccurrence of Achilles Tendonitis

To prevent reoccurence of Achilles tendonitis it's extremely important to follow through with rehabilitation recommendations. Achilles tendonitis that isn't adequately treated can progress to a degenerative condition called Achilles tendonosis. Other things to consider for prevention are:

Purchase Proper Footwear

Footwear made for the sport you play is essential in preventing reoccurence of Achilles tendonitis. If you're a runner, check out "How to Buy the Best Running Shoes for Your Feet"

Gradually Increase Your Training Time

You might want to get ready to run that race with your friends and end up overdoing it. Unfortunately your Achilles can't adapt that quickly to a huge increase in your training regimen. Do your Achilles a favor--increase training time by no more than 10% a week to avoid injury.

Vary Your Terrain

In Seattle you have lots of opportunity to get a great workout on hills. But don't overdo it or you'll increase you Achilles tendonitis risk. Vary the type of terrain you run or hike on from day to day or even on the same day. Do hills one day and run Greenlake another day. Mix it up.

Don't Forget to Warm-up

Both new and veteran athletes should warm up before working out. Dynamic warm-ups for runners are very effective.

Change Up Your Exercise Routine

You might love your sport but it's great to take a break by doing something different like swimming or cycling to reduce strain on your Achilles.

Time to Try Custom Orthotics

If you've tried OTC non-prescription orthotics and they aren't working for you, you may need custom orthotics. 

Learn about other sports injury treatment here.