What is Achilles tendinitis?
The Achilles tendon connects the calf muscles to the heel bone. It works every time you walk, run, climb stairs, jump or stand on tiptoe. When it is overloaded again and again, it can become painful and thicken.
People often say "tendinitis", but inflammation does not explain everything: the tendon changes its structure and tolerates load less well. That is why doctors speak of tendinopathy. To understand this process, read Tendinopathy: why tendon pain persists.
The AAOS describes two forms:
- in the middle of the tendon (called non-insertional), more common in younger, active people, especially runners;
- where the tendon attaches to the heel (called insertional), which can appear at any activity level.
For care options, see our Tendinitis and Sports injuries pages. This article focuses on symptoms and daily life.
Achilles tendinitis: what are the symptoms?
According to the AAOS, common signs are:
- pain and stiffness along the tendon in the morning, with the first steps;
- pain along the tendon or at the back of the heel that gets worse with activity;
- marked pain the day after exercise;
- a thickened tendon;
- when the pain is where the tendon attaches to the heel (insertional form), sometimes a bony bump at the back of the heel.
Swelling that is there all the time and grows through the day, and pain at the back of the heel in shoes, are also described. Pain under the heel, on the sole of the foot, points rather to another cause: read Plantar fasciitis: heel pain.
Why does the Achilles tendon become painful?
Most often there is no single injury, but repeated load that the tendon has not had time to absorb. The AAOS lists:
- a sudden increase in the amount or intensity of activity, for example more kilometres or hills;
- tight calves;
- a change of shoes or surface;
- a bony bump at the back of the heel (Haglund's deformity), which can rub on the tendon near where it attaches.
How is it diagnosed?
Your doctor asks about your activities and examines the tendon: the painful area, thickening, ankle mobility and calf flexibility. According to the AAOS, an X-ray can show a bony bump at the back of the heel or calcification (a small hard deposit) in the tendon, ultrasound can complete the examination, and an MRI is not needed to make the diagnosis. It can be useful if surgery is being considered.
Achilles tendinitis: what to do day to day?
Adjust the load without stopping everything. Temporarily reduce what brings on the pain, such as running, jumping or hills, and keep up a low-impact activity (cycling, swimming, walking on flat ground) if it stays comfortable.
Stretch the calf. The AAOS suggests holding the stretch for 30 seconds and repeating it 10 times on each foot: you feel the stretch in the calf, without pain in the tendon. Your physiotherapist shows you the right position.
Strengthen gradually. According to the AAOS, eccentric calf strengthening (the calf works while braking: you slowly lower your heel from a step) can be useful when the pain is in the middle of the tendon (non-insertional form), but should be avoided when the pain is where the tendon attaches to the heel (insertional form). Learn it first with a physiotherapist, who adapts the load to your tendon.
Cold. According to the AAOS, ice on the most painful area, for up to 20 minutes at a time, can bring relief. Remove it sooner if the skin goes numb.
Shoes and night-time. When the pain is where the tendon attaches to the heel (insertional form), softer shoes or shoes open at the back of the heel and a heel lift can reduce strain on the tendon. A night splint can ease the pain of the first steps in the morning: discuss it with your doctor.
Medicines and injections. Ask your doctor or pharmacist before taking anti-inflammatories, and talk to your doctor if you still need them after a few weeks. The AAOS does not recommend cortisone injections into the Achilles tendon, because of the risk of rupture. For alternatives, read Tendinopathy without cortisone.
Warning signs: when to seek help without delay
Go to the emergency department if:
- you feel a sudden pop or "kick" at the back of the heel, with sharp pain;
- you can no longer stand on tiptoe or walk normally.
The tendon may have torn: prompt care is important. A tear is different from tendinitis, and according to the AAOS, in most cases of Achilles tendinitis, non-surgical care provides acceptable pain relief.
See your doctor soon if:
- the tendon stays swollen all the time and the swelling increases;
- the pain gets worse despite a few weeks of adjustment.
Looking beyond the tendon
The first consultation lasts 1.5 to 2 hours (CHF 182). Bring your medical file, your test results (X-ray, ultrasound, reports) and the list of your medications. We review your situation and build your plan together. Follow-up is then adapted to your progress. We work alongside your GP and the other professionals who care for you, in particular your physiotherapist.
Which approaches can play a part at Centre Algos?
Depending on your situation, several approaches can be combined, alongside your medical follow-up:
- Naturopathy: sleep, recovery, diet and daily rhythm, to work on the habits that can influence pain.
- Cupping: applied to the calf, away from the painful tendon, it can help release muscle tension.
- Functional biology and micronutrition: a review of diet and nutritional needs, taking your related conditions and medications into account.
- Percutaneous hydrotomy: micro-injections under the skin. After assessment, when no warning signs are present and in agreement with your medical care, it can be discussed as a complementary option; it can bring relief, with no guaranteed result. We explain how it works, its limits and its contraindications; results vary from person to person. If hydrotomy is part of your plan, price on quotation, set at the first consultation according to your situation.
Everyone responds differently: the aim is to help you live your days better, without promising a result.
When to seek advice
What happens in your case
This text gives general guidance. What keeps your tendon pain going, in your daily life and your sport, deserves a real conversation rather than a generic answer.
A question before you decide? Book a free 10-minute call to see whether our approach suits you.
