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Achilles Tendinopathy

(Achilles Tendonitis; Achilles Tendinosis)
  • Definition

    Tendons connect muscle to bone and often connect near a joint. Tendinopathy is an injury to the tendon. It can cause pain and swelling and makes it difficult to move. Tendinopathy may be:
    • Tendonitis—inflammation of the tendon
    • Tendinosis—tiny tears in the tendon with no major inflammation
    The Achilles tendon connects the calf muscle to the heel bone. An achilles tendinopathy is pain in this tendon.
    Achilles Tendonitis
    Achilles Tendonitis
    Copyright © Nucleus Medical Media, Inc.
  • Causes

    Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon.
    Overuse of the Achilles tendon can occur with activities such as:
    • Increasing your speed or running long distances too quickly
    • Suddenly adding strenuous hills or stair climbing to your exercise routine
    • Doing too much too soon after taking time away from exercising
    • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
    • Running too much
    • Lack of flexibility of the calf muscles
  • Risk Factors

    Achilles tendinopathy is more common in older adults due to the aging process. Factors that may increase your risk of getting Achilles tendinopathy include:
    • Improper or badly worn footwear
    • Inflexibility of the calf muscles
    • An improper training program—such as increasing intensity too quickly
  • Symptoms

    Symptoms of tendinopathy may include:
    • Tenderness—usually just above the heel bone and often more noticeable in the morning
    • Stiffness that gradually eases as the tendon is warmed-up
    • Pain after activity that gradually worsens
    • Pain along the tendon during and/or after running
    • Swelling in the area of the Achilles tendon
    • Pain at the back of the ankle
  • Diagnosis

    You will be asked about your symptoms and exercise habits. A physical exam will be done. A diagnosis will be made based on the exam and history.
    Images of the bones and tendons may be taken. This can be done with:
  • Treatment

    Tendinopathy and the associated pain may take months to resolve. It can be frustrating, but it is important to follow through with the advised treatment.
    Supportive Care
    The tendon will need time to heal. Treatment may include:
    • Restricting activities
    • Ice therapy to help relieve swelling
    • A shoe insert that places the foot in the correct position
    • Ankle taping to support the area
    Prescription or over-the-counter medications may be advised to reduce pain.
    Physical Therapy
    A physical therapist will assess the tendon. Ultrasound and/or massage may be done to help relieve tension.
    An exercise program will be created to help recovery and to strengthen the calf muscles.
  • Prevention

    To decrease your chances of getting Achilles tendonitis:
    • Wear appropriate footwear for your sport.
    • Replace footwear that shows signs of wear.
    • Gradually add hill work, stairs, speed, and distance to your routine.
    • Stretch and strengthen the calf muscles regularly.

    American College of Sports Medicine

    OrthoInfo—American Academy of Orthopaedic Surgeons


    Canadian Orthopaedic Association

    Canadian Orthopaedic Foundation


    Achilles tendinopathy. EBSCO DynaMed website. Available at: Updated June 26, 2015. Accessed February 29, 2016.

    Achilles tendinitis. Ortho Info—American Academy of Orthopaedic Surgeons website. Available at: Updated June 2010. Accessed February 29, 2016.

    Common disorders of the achilles tendon. American College of Foot and Ankle Surgeons Foot Health Facts website. Available at: Accessed February 29, 2016.

    de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026-1028.

    Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933-939.

    10/26/2010 DynaMed's Systematic Literature Surveillance Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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