Achilles Tendinitis: Causes, Symptoms, Home Care and When to Worry

If the back of your heel aches when you get out of bed, or your lower calf feels tight and sore after a hike or a run, your Achilles tendon may be the cause. Achilles tendinitis is a common condition. It happens when the large tendon that runs down the back of your lower leg becomes irritated and inflamed.¹

Here's what causes it, how to care for it at home, when to see a podiatrist, and the warning signs of a torn (ruptured) tendon.

What Is the Achilles Tendon, and What Is Tendinitis?

Your Achilles tendon is the band of tissue that connects your calf muscle to your heel bone. It helps you walk by raising your heel off the ground.³ It is also the largest tendon in the body.¹

Achilles tendinitis (also spelled tendonitis) is inflammation of this tendon.² The American College of Foot and Ankle Surgeons (ACFAS) explains that this inflammation is usually short-lived. But if it isn't resolved, it can progress to a condition called tendonosis. In tendonosis, the tendon "loses its organized structure and is likely to develop microscopic tears."³ You may also see these problems grouped together as Achilles tendinopathy.

There are two main types, based on where the pain is:^1,2

• Noninsertional: the middle part of the tendon, above where it attaches to the heel. This type is more common in younger, active people and runners.¹
• Insertional: the lower part, where the tendon attaches to the heel bone. This type can affect anyone, including people who aren't very active.²

What Causes Achilles Tendinitis?

Most of the time it's an overuse problem. ACFAS notes it usually comes from a sudden increase in a repetitive activity that puts too much stress on the tendon too quickly.³ Things that can raise your risk include:

• Suddenly increasing how hard or how long you exercise^1,4
• Tight calf muscles^1,4
• Changing shoes, or wearing shoes without good support^1,4
• Running on hard surfaces⁴
• Flat feet or overpronation (arches that flatten too much)^2,3,4
• A bone enlargement at the back of the heel (Haglund's deformity) or bone spurs^1,2

Runners, dancers and people who play sports with quick stops are at higher risk. So are people who work on their feet doing physical labor, and "weekend warriors" who exercise only now and then.^2,3 MedlinePlus notes that overuse tendinitis is most common in younger people. In older adults, arthritis can cause bone spurs that irritate the tendon.⁴

What Does Achilles Tendinitis Feel Like?

Common symptoms include:

• Pain and stiffness along the tendon in the morning^1,4
• Pain that gets worse with activity, or after you've been resting^1,3
• Pain in the heel or along the tendon when you walk or run⁴
• Swelling or warmth around the tendon^2,4
• Thickening of the tendon¹
• Trouble standing up on your toes⁴

Heel pain has other causes too. Our page on heel pain covers some of the other common culprits.

What Can I Do at Home?

For mild pain, sources suggest:

• Rest and change activities. Stop the activities that make your pain worse. Switch to lower-impact exercise, like swimming or cycling. Then increase your activity gradually.^2,5
• Ice. MedlinePlus suggests icing the tendon for 15 to 20 minutes, two to three times a day.⁵ Other sources suggest different schedules,^2,3 so ask your provider what's right for you.
• Over-the-counter pain relievers. Medicines like ibuprofen or naproxen may help with pain and swelling.⁵ Cleveland Clinic and AAOS advise not taking them for more than a month without talking to a provider.^1,2 Check with your provider first if you have heart disease, kidney problems or a history of stomach ulcers.⁵
• Supportive shoes and heel lifts. Supportive footwear and heel lifts are commonly suggested.^1,2
• Stretching and strengthening. A provider or physical therapist may show you calf stretches or eccentric loading exercises. These are strengthening moves where the calf muscle lengthens as it works.^1,4 Do them gently to avoid further injury.⁵

Be patient. MedlinePlus says it may take at least two to three months for the pain to go away.⁴ Cleveland Clinic notes it can take longer if you've already had symptoms for a few months.²

When Should I See a Podiatrist?

MedlinePlus advises contacting your provider if your symptoms don't get better within two weeks of self-care, if you have sharp ankle pain, or if walking or standing becomes hard.⁵ Cleveland Clinic also advises getting care for severe pain or symptoms that last more than a few weeks.²

A podiatrist can examine your tendon, check for other causes of pain, and talk with you about treatment. Depending on your situation, options described by AAOS and ACFAS include physical therapy, night splints, a walking boot, custom orthotics and, in some cases, shockwave therapy.^1,3 MedlinePlus notes that the main treatments don't involve surgery.⁴ AAOS notes surgery may be considered if pain doesn't improve after about six months of nonsurgical treatment.¹ Learn more about how we approach ankle pain.

How Do I Know if My Achilles Is Torn?

MedlinePlus notes that Achilles tendinitis can raise the risk of an Achilles rupture.⁴ Ruptures often happen with sudden force on the tendon, such as landing from a jump, stopping fast, pivoting or changing direction. Slipping, tripping or missing a stair can also cause one.^6,7 Warning signs include:^6,7

• Feeling or hearing a pop in your calf or heel
• Feeling like you were hit or kicked in the back of the heel or calf
• Sudden sharp pain near your heel, though some people feel little pain when it happens
• Sudden swelling or bruising at the back of the ankle
• Trouble walking, or not being able to point your toes down or stand on the toes of that leg

Some medicines can weaken the tendon and raise the risk of a tear. These include fluoroquinolone antibiotics (such as ciprofloxacin or levofloxacin) and corticosteroids.^6,7

Don't wait on a suspected rupture. Cleveland Clinic advises seeing a provider right away, noting that "the faster you get it diagnosed, the better."⁶ AAOS adds that people who need surgery tend to do better when the repair is done soon after the injury.⁷ Call our office, or go to an emergency room if your symptoms are severe.

Can I Prevent It?

Sources suggest a few habits that may lower your risk: warm up with calf stretches, increase exercise intensity gradually, mix up your activities, and wear supportive shoes that suit your feet.^2,3 Regular calf stretching and strengthening is also recommended.^3,4 For more on choosing shoes, see our article on proper footwear.

The Bottom Line

Achilles tendinitis is a common overuse problem that causes pain and stiffness at the back of the heel. Rest, ice, supportive shoes and gentle stretching may help mild cases, but recovery can take a few months. If self-care isn't helping after a couple of weeks, have it checked. And if you feel a sudden pop or can't push off or walk normally, treat it as urgent and call right away.

If Achilles pain is slowing you down, our podiatrists can help. Request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

1. Achilles Tendinitis. OrthoInfo, American Academy of Orthopaedic Surgeons (AAOS). www.orthoinfo.org
2. Achilles Tendinitis: Symptoms & Treatment. Cleveland Clinic. my.clevelandclinic.org
3. Achilles Tendon Disorders. American College of Foot and Ankle Surgeons (FootHealthFacts.org). www.foothealthfacts.org
4. Achilles Tendinitis. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
5. Heel Pain and Achilles Tendonitis – Aftercare. MedlinePlus Medical Encyclopedia, U.S. National Library of Medicine. medlineplus.gov
6. Achilles Tendon Rupture: Symptoms, Treatment & Recovery Time. Cleveland Clinic. my.clevelandclinic.org
7. Achilles Tendon Rupture (Tear). OrthoInfo, American Academy of Orthopaedic Surgeons (AAOS). www.orthoinfo.org