While one of the most common heel pain conditions I see is plantar fasciitis, Achilles tendonitis is a close second. The Achilles tendon is the largest tendon in the body. While it can handle forces of 1,000 pounds or more it’s not infallible. When it becomes inflamed it can sideline even the most seasoned athlete. And while runners and other outdoor enthusiasts are more prone to developing it, non-athletes can also acquire it. That’s because the Achilles tendon plays a large role in helping us run and walk. Today I’ll be talking about what causes Achilles tendonitis, it’s symptoms, treatments, and how to prevent it from recurring.

Risk Factors for Achilles Tendonitis

As I mentioned, while Achilles tendonitis can affect anyone, runners and other athletes are at greater risk for developing it due to the repetitive stress put on the tendon. Here are some specific factors that also increase the likelihood of acquiring it.

  • Running uphill or climbing stairs
  • Increasing your distance or speed too quickly while walking, running, or playing your sport
  • Starting exercise too soon after a period of inactivity without proper foot stretching and warm-up
  • Wearing inappropriate footwear including worn out shoes.
  • Having an abnormal foot structure, such as flat feet with a tendency to overpronate
  • Tight calf muscles
  • Being older
  • Having certain medical conditions like psoriasis and high blood pressur
  • Taking certain drugs called fluoroquinolones, such as cipro or levaquin used to treat infections

Symptoms of Achilles Tendonitis

Achilles tendonitis often begins with mild pain in the back of the heel or leg after exercise that gradually worsens over time. Other symptoms include:

  • Pain, stiffness, and tenderness in the back of the heel first thing in the morning and after rest. Symptoms will usually decrease with movement.
  • Pain in the back of your heel when you wear shoes.
  • Swelling along the back of your heel.
  • Tenderness, or sometimes intense pain can be experienced when the side of the tendon is squeezed.

Treatment of Achilles Tendonitis

To effectively treat Achilles tendonitis it's important to address the three key factors involved in its development and pain: inflammation, tight calf muscles, and abnormal foot mechanics.

How to Reduce Your Inflammation

  • Stop your current exercise. I know you probably don’t want to but if you’re going to heal, this is very important. Athletes who continue to play on an injured Achilles risk an Achilles tendon rupture.
  • Add a heel lift to your shoes. You may be able to immediately reduce stress on the Achilles tendon and pain by adding a ¼ inch heel lift to your shoe. Apply it to both shoes under the insole if possible.
  • Start icing- icing not only helps reduce the pain but also the inflammation which drives the pain. You can fill up a dixie cup with water, freeze it and then tear down the sides. Ice for up to 20 mins several times a day.
  • Consider using anti-inflammatory medications - these can reduce pain and inflammation as long as your doctor recommends it.
  • MLS laser therapy. Another great tool for healing is MLS laser therapy. We apply this therapy right in our office. This cold laser reduces pain and inflammation and helps heal at the cellular level.

How to Address Abnormal Foot Mechanics

Often abnormal foot mechanics such as flat feet play a significant role in development of Achilles tendonitis. To properly align flat or pronated feet in moderate to severe cases, we use custom orthotics. If you have a milder case, you can try over-the-counter inserts first such as Powerstep or Redithotics. However, if you've tried over-the-counter inserts or orthotics and they aren't working for you, you probably need custom orthotics. While over-the-counter inserts may give you some arch support they won’t provide the alignment you may need to prevent Achilles tendonitis from coming back.  Also, custom orthotics will last up to 3 years depending on how much exercise you do, whereas, non-custom arch supports will only last about 6 months.

How to Address Tight Calf Muscles

Stretching is critical for those with tight calf muscles. To get the proper stretch I advise my patients to use an Achilles splint during the day for 30 minutes a day.

Because morning pain is often a problem due to tight calf muscles its also a good idea to properly stretch before getting out of bed. 

Other Treatments for Achilles Tendonitis

  • Walking boot. - In severe cases of Achilles tendonitis, immobilization with a walking boot may be required.
  • Physical therapy - can also help in strengthening areas around the Achilles, obtaining gait and running training, and use of ultrasound for healing.

Prevention of Achilles Tendonitis

Fortunately, there are a lot of steps you can take to prevent yourself from developing this condition in the first place. And many of those steps can also prevent a recurrence. If you’ve had Achilles tendonitis before it’s critical to follow through on all the treatment recommendations to avoid a degenerative condition called Achilles tendonosis.

Other things to consider for prevention are:

  • Purchasing the right footwear. This is essential in preventing a recurrence of Achilles tendonitis.  It’s important to purchase footwear made for the sport you play. For example, lbuy running shoes for running, court shoes for playing tennis or pickleball, cleats for playing soccer, basketball shoes for basketball and so on. Check out my video for buying running shoes below.
  • Increase your training time slowly. Your Achilles tendon can’t adapt quickly to a big increases in training. Take some days off in between runs or whatever sport you engage in and don’t increase the amount you work out by more than 10% a week to avoid injury. Changing up the type of exercise is also beneficial. Try doing yoga, biking or swimming to give your Achilles tendon a rest, before returning to hiking or running.
  • Vary the terraini you run on.  In Seattle you have lots of opportunity to get a great workout on hills. But don't overdo it or you'll increase your Achilles tendonitis risk. For example, if you work out on hills one day, consider running around Greenlake the next day.
  • Always warm-up before working out. Dynamic warm-ups for runners are very effective.  After working out static stretches are important (see video above).
  • Always wear your custom orthotics - if you have them, don't just wear your custom orthotics when engaged in sports. It's important to wear them all the time to prevent a recurrence.

To learn more about Achilles tendonitis in runners, click here!

Video on Achilles tendonitis in hikers (see below)

In conclusion, I hope you now have a better understanding of what you can expect at your podiatrists office if you develop Achilles tendonitis. But more importantly, now you have tools you can use to prevent it from developing in the first place.

Dr. Rion Berg
Connect with me
A podiatrist in North Seattle treating families for over 40 years.