The Achilles tendon is the powerhouse ofthe lower leg. It connects the calf muscles to the heel bone and is essentialfor walking, running, and jumping. Despite being the strongest tendon in thebody, it is also one of the most frequently injured. Achilles tendonitis, which refers to inflammation, irritation, ordegeneration of the tendon, is a common condition in athletes, active adults,and even people who suddenly change their activity levels. The good news isthat with the right care, most cases heal well. Left untreated, however,Achilles tendonitis can progress into chronic pain, lasting disability, or evena complete rupture.
Achilles tendonitis is rarely caused byone traumatic event. Instead, it develops from repetitive stress thatoverwhelms the tendon’s ability to repair itself. The most common cause is asudden increase in physical activity. Someone who starts running longerdistances, adds hills or speed workouts, or returns to sports after months ofrest is particularly vulnerable. The tendon, which thrives on gradual,progressive loading, does not have time to adapt.
Foot mechanics also play a role. Peoplewith flat feet tend to roll inward excessively when they walk, which twists andstrains the tendon. Those with very high arches may transmit more forcedirectly through the tendon, increasing the risk of injury. Poor footwearchoices amplify these risks. Shoes without proper cushioning or with worn-outmidsoles force the tendon to absorb more shock.
Tight calf muscles further increasetension. When the calf cannot stretch adequately, the Achilles tendon has tocompensate during walking and running, especially when climbing stairs orhills. Age is another factor. As we grow older, tendons lose some of theirelasticity and blood supply, making them more prone to microtears. Certainmedications, including some antibiotics and steroid use, have also been linkedto tendon problems, which is why a full medical history is important duringevaluation.
The first sign of Achilles tendonitis isusually a dull ache or stiffness in the back of the heel or just above it. Manypatients report the pain is worst in the morning or after sitting for longperiods. Once they start moving, the tendon loosens and feels better, only totighten up again after activity.
As the condition progresses, pain mayappear during exercise or even simple daily activities like walking, standing,or climbing stairs. Swelling or thickening along the tendon is common, and insome cases a painful lump may form. Pressing on the tendon often triggerstenderness. Insertional tendonitis, which affects the point where the tendonattaches to the heel bone, can be aggravated by stiff shoes or direct pressurefrom footwear. Mid-portion tendonitis, higher up the tendon, is often linked tooveruse from running.
If pain is ignored and activitycontinues, the tendon fibers may degenerate, leading to chronic tendinopathy.In severe cases, a sudden sharp pain followed by difficulty walking mayindicate a rupture, which requires immediate medical attention.
Achilles tendonitis doesn’t justinterfere with sports. It can disrupt ordinary routines. Patients oftendescribe hobbling to the bathroom in the morning, struggling to climb stairs,or limping after long days on their feet. Athletes may be forced to stoptraining entirely, while workers in physically demanding jobs may find itdifficult to perform daily tasks. The loss of mobility can impact overallhealth and fitness, as well as mood and confidence.
Most cases of Achilles tendonitis improvewith conservative care. The first step is reducing the activity that triggeredthe pain. This doesn’t always mean complete rest but switching to lower-impactalternatives such as swimming or cycling. Ice and elevation can reduceswelling, while supportive shoes with cushioning and sometimes a temporary heellift help relieve tension.
Physical therapy is the cornerstone oftreatment. Stretching the calf muscles restores flexibility, while eccentricstrengthening exercises, where the foot is slowly lowered against resistance,have been shown to improve tendon healing. Therapists may also use soft tissuemobilization, ultrasound, or manual techniques to enhance blood flow and tissuerepair. Orthotics may be prescribed if poor biomechanics contribute to theproblem, especially in patients with flat feet.
Over-the-counter anti-inflammatorymedications may help short-term, but they do not address the underlyingmechanical issues. Cortisone injections are generally avoided near the Achillestendon because they can weaken the tissue and increase the risk of rupture.
For patients who do not improve withconservative care, advanced therapies may be considered. Shockwave therapy is a noninvasive treatment that delivers sound waves tothe tendon, stimulating blood flow and healing. Platelet-rich plasma (PRP)injections, which use growth factors derived from the patient’s own blood, areincreasingly used to promote tendon repair. Ultrasound-guided procedures suchas percutaneous tenotomy can remove scar tissue and encourage regeneration.
Surgery is reserved for severe or chroniccases where conservative and advanced treatments fail. Surgical approaches mayinclude removing damaged tendon fibers, repairing tears, or reattaching thetendon to the heel bone. Recovery from surgery typically takes several months,and physical therapy is crucial afterward to restore mobility and strength.
Recovery from Achilles tendonitis variesdepending on severity. Mild cases may resolve in six to eight weeks with propercare. More chronic conditions may require three to six months of structuredtherapy. Athletes often follow a staged return-to-sport program, starting withpain-free walking, then progressing to light jogging, and eventually fulltraining. A full rupture that requires surgical repair can take nine to twelvemonths before return to high-level sports.
Preventing Achilles tendonitis requires acombination of smart training, supportive footwear, and body awareness.Gradually increasing mileage or activity allows the tendon to adapt. Regularcalf stretching and strengthening exercises improve flexibility and resilience.Shoes should be replaced before cushioning wears out, and those with footstructure issues may benefit from orthotics. Warming up before activity andcooling down afterward are often overlooked but reduce strain on the tendon.Above all, listening to early warning signs such as morning stiffness orswelling can prevent minor irritation from becoming a chronic condition.
There are a few myths worth clarifying.One is that tendonitis is always caused by inflammation. In reality, manychronic cases involve degeneration of tendon fibers rather than activeinflammation, which is why strengthening exercises are more effective than restalone. Another myth is that stretching harder and longer will solve theproblem. While gentle stretching is important, aggressive stretching can worsensymptoms. Finally, the idea that “walking it off” will make tendon pain go awayis misleading and often dangerous. Ignoring the pain risks progression torupture.
Achilles tendonitis is one of the mostcommon overuse injuries of the foot andankle, but it is also one of the most treatable when addressed early. Acombination of rest, supportive footwear, physical therapy, and, when needed,advanced treatments can restore strength and function. With patience and properguidance, most people return to full activity without pain. If you areexperiencing persistent heel or tendon pain, consulting Dr. Kamel can help you finda tailored plan and prevent further injury.