Achilles tendinitis, more broadly referred to as Achilles tendinopathy, is an overuse injury affecting the Achilles tendon, the strong band of tissue that connects the calf muscles to the heel bone (calcaneus). The Achilles tendon plays an important role in walking, running, jumping, climbing stairs, and other movements of the foot and ankle. Achilles tendinopathy commonly develops gradually because of repeated stress on the tendon. It may cause pain, stiffness, tenderness, or swelling at the back of the ankle or heel. It is particularly common among runners and people who participate in sports involving running and jumping. Although Achilles tendinopathy can affect anyone, the risk increases with age and with activities that place repeated strain on the tendon. It is also reported more frequently in men than women. The condition is sometimes called Achilles tendonitis, Achilles tendinopathy, or calcaneal tendinopathy. The term “tendinopathy” is often preferred because persistent Achilles tendon problems may involve degeneration and structural changes in the tendon rather than inflammation alone.
This affects the lower portion of the Achilles tendon where it attaches to the heel bone. It may occur at any age but is particularly common in older adults. Pain may be aggravated by activities that put pressure on the back of the heel, such as walking uphill or wearing certain shoes.
This affects the middle portion of the Achilles tendon, usually a few centimeters above its attachment to the heel bone. It is particularly common among physically active people and athletes. The affected area may become swollen or thickened and may be painful during exercise.
Achilles tendinopathy generally develops when the tendon is subjected to repeated stress without enough time to recover. Possible causes and contributing factors include:
A sudden increase in physical activity
Increasing running distance or intensity too quickly
Exercising without adequate preparation
Repetitive running or jumping
Repeated strain on the calf muscles
Sports involving frequent stopping, starting, jumping, or changes in direction
Wearing poorly fitting or unsuitable footwear
Wearing high-heeled shoes for prolonged periods
Tight calf muscles
Reduced flexibility of the ankle or calf
Flat feet or changes in the foot arch
Abnormal foot mechanics
Bone spurs at the back of the heel
Age-related changes in the tendon
Being overweight or obese
Inadequate recovery between strenuous activities
Sports such as running, tennis, basketball, soccer, and other activities involving repetitive running or jumping can increase stress on the Achilles tendon.
Some medications have been associated with tendon injury. Fluoroquinolone antibiotics, in particular, have been linked to an increased risk of tendinopathy and tendon rupture. Some other medicines may also affect tendon health. People taking medications should not stop prescribed treatment without consulting their doctor.
A healthcare professional usually diagnoses Achilles tendinopathy based on the person’s symptoms, medical history, physical examination, and activity level. During the examination, the healthcare professional may:
Reducing or temporarily avoiding activities that aggravate pain can help the tendon recover. Complete prolonged immobilization is not always necessary; a healthcare professional can recommend appropriate activity levels. Low-impact activities such as swimming or cycling may sometimes be suitable alternatives, depending on the severity of symptoms.
Physiotherapy is an important part of treatment for many people with Achilles tendinopathy. A physiotherapist may recommend exercises that gradually strengthen the calf muscles and Achilles tendon. These may include:
Calf strengthening exercises
Controlled heel raises
Stretching and mobility exercises
Progressive tendon-loading exercises
Balance and movement exercises
Exercises should be progressed gradually and according to professional guidance, particularly when pain is significant.
Supportive, properly fitting footwear may reduce unnecessary stress on the Achilles tendon. In selected cases, a healthcare professional may recommend shoe modifications or orthotic devices.
Depending on the individual’s health and the cause of pain, a healthcare professional may recommend appropriate pain-relieving medication. Because anti-inflammatory medicines are not suitable for everyone and Achilles tendinopathy is not simply an inflammatory condition, medication should be used according to medical advice.
For persistent or severe symptoms, a specialist may consider additional treatment options based on the individual’s condition. Treatment for an Achilles tendon rupture is different and may involve immobilization, rehabilitation, or surgical repair depending on factors such as the type of rupture, age, activity level, and overall health.
Untreated or poorly managed Achilles tendinopathy may become persistent and interfere with everyday activities and sports. Possible complications include:
Chronic Achilles tendon pain
Persistent stiffness
Reduced physical activity
Tendon thickening or structural changes
Reduced athletic performance
Increased vulnerability to tendon injury
Achilles tendon rupture
A sudden increase in pain accompanied by a popping sensation, weakness, or difficulty walking may indicate a tendon rupture and requires prompt medical assessment.
The terms are often used interchangeably, but Achilles tendinopathy is generally a broader and more appropriate term for chronic tendon problems involving pain and structural changes. Tendinitis specifically implies inflammation.
Mild cases may improve with appropriate activity modification and rehabilitation. However, persistent or worsening symptoms should be evaluated by a healthcare professional.
This depends on the severity of the condition. Activities that significantly increase pain should generally be reduced or modified. A physiotherapist or sports medicine specialist can help develop a safe exercise program.
Walking may be tolerated in mild cases, but excessive walking or walking that significantly increases pain can aggravate symptoms. Activity should be adjusted according to symptoms and professional advice.
Recovery varies considerably. Mild symptoms may improve over several weeks, while chronic Achilles tendinopathy can require several months of progressive rehabilitation.
An unhealthy or weakened Achilles tendon may be more vulnerable to rupture, particularly when exposed to sudden, forceful loading. However, not every person with Achilles tendinopathy will experience a rupture.
Regularly wearing high heels can shorten or tighten the calf-Achilles complex and may contribute to Achilles tendon problems in some people. Switching suddenly from prolonged high-heel use to flat shoes can also increase tendon strain.
They are common in athletes and physically active people, particularly those involved in running and jumping sports. However, Achilles tendinopathy can also occur in people who are not athletes.
Medical Disclaimer
This article is intended for general informational and educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Do not start, stop, or change any treatment based solely on information provided in this article.
