Achilles Tendon Pain: Symptoms, Causes, and Treatments

Understanding Achilles tendonitis, tendinosis, and tendon ruptures

Injury to your Achilles tendon can cause pain, burning, redness, and swelling. The Achilles tendon is a thick tendon that attaches your calf muscles to your heel bone. It is crucial for walking, running, and jumping.

Like all tendons, the Achilles tendon is strong, but not very flexible. It can only stretch so far. When it goes beyond its limits, it becomes inflamed (tendonitis) or tears (rupture). Stress or injury to the Achilles tendon can cause discomfort that can range from a slight ache and stiffness to severe Achilles tendon pain.

Over time, untreated inflammation can develop into a degenerative condition called tendinosis. Treatment for Achilles tendon pain may involve self-care, immobilization, surgery, or a combination of therapies.

This article covers Achilles tendonitis, tendinosis, and rupture and how they can cause Achilles tendon pain. It will also discuss when to see a healthcare provider, what diagnosis entails, and how Achilles tendon pain can be treated and prevented.

Stretching by the frozen lake
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Achilles Tendonitis

The two most common causes of Achilles tendon pain are Achilles tendonitis and Achilles tendinosis. While these conditions sound similar, they describe two different problems.

Achilles tendonitis is an inflammatory injury of the Achilles tendon. It most commonly affects athletes, particularly runners, and people who play sports like tennis that require lots of starts, stops, and turns.

If you have Achilles tendonitis, you may experience pain or burning, in addition to warmth, redness, and swelling in and around the tendon itself.

Causes of Achilles Tendonitis

More often than not, repetitive stress to the Achilles tendon is the cause of Achilles tendonitis. Rarely does an injury cause tendonitis. Here's how exercise and certain medical conditions can cause additional stress on the tendon.

Exercise Pitfalls

Achilles tendonitis can happen when people don't warm up the calf muscles before exercising, or suddenly increase how much exercise they are doing overall. The tighter the calf muscles, the more tension that's placed on the Achilles tendon. You can also get Achilles tendonitis if you try to do too much, too quickly.

Exercising in worn-out sneakers, or in shoes that aren't designed for the activity, can cause Achilles tendonitis. Running on hard surfaces, like concrete, and jumping often, like when playing basketball, can also irritate the Achilles tendon.

Other factors that may be triggers include:

  • Cold weather training
  • Misaligned feet or flat fleet
  • Poor running form
  • Leg length differences

Bone Spurs

Sometimes, Achilles tendonitis is caused when a bony growth develops on the heel or calcaneus bone, which is at the back of the ankle. This may be a bone spur from arthritis. It also may be a Haglund's deformity that comes from wearing ill-fitting shoes. The growth may rub on the Achilles and cause pain and inflammation. Putting pressure on the back of the heel from laying down on the bed can hurt.

Obesity and Other Medical Conditions

Obesity puts pressure on the lower body, which can cause Achilles tendon pain. Other medical conditions, such as psoriasis and high blood pressure, also have been linked to a higher risk of Achilles tendonitis.

Certain Medications

Fluoroquinolones are widely used medications in the treatment of a number of different infections including gastrointestinal, respiratory, genital and urinary, and eye infections. Scientific evidence suggests tendonitis is one side effect of these medications. It tends to show up soon after you start taking the medication. Of the fluoroquinolones, ciprofloxacin seems to pose the highest risk of tendonitis.

Symptoms of Achilles Tendonitis

The pain caused by Achilles tendonitis and Achilles tendinosis is similar, but there is one key difference between the two: Achilles tendonitis causes inflammation in the tendon whereas Achilles tendinosis does not.

Signs that you may have Achilles tendonitis include:

  • Pain in the heel and along the length of the tendon when walking or running
  • Painful and stiff Achilles tendon in the morning
  • Tenderness and pain when you touch or move the tendon
  • Swelling and warmth in the area
  • Trouble standing on your toes
  • Trouble finding comfortable shoes to fit with pain in the back of the heel

The exact site of the pain may vary. It can be felt closer to the bottom of the calf muscle, along the actual tendon, or lower down near the heel bone.

Wearing orthotics, doing light Achilles tendon stretches, and taking pain medications can help.

Some people have tendonitis without Achilles tendon pain. They don't actually know there is a problem, so they don't seek treatment. This can cause the condition to progress to tendinosis.

Achilles Tendinosis

Achilles tendinosis describes a chronic (long-term) tendon condition. It results from untreated tendonitis. With tendinosis, the collagen fibers that make up the tendon break down.

The primary symptom of Achilles tendinosis is pain. You may also experience burning in the tendon area, but without warmth, redness, and swelling seen in Achilles tendonitis. That's because tendinosis is a degenerative disease, not an inflammatory one.

The causes of Achilles tendinosis are less clear. Theories abound and include overuse, decreased blood supply and tensile strength with aging, muscle imbalance or weakness, insufficient flexibility, and more.

Achilles Tendon Rupture

Though rare, an Achilles tendon rupture can also be the cause of Achilles tendon pain. An Achilles tendon rupture happens when the tendon fibers tear and separate, either completely or in part. You may or may not need surgery depending on the extent of your injury and other health factors.

Causes of Achilles Tendon Rupture

Achilles tendon rupture can occur when a sudden force is exerted upon the tendon, which often happens with sudden pivots of the foot (e.g., when playing basketball). Even a sudden step off a curb or a simple trip can sometimes be enough to overstretch and tear the tendon.

Rupture of the Achilles tendon is often seen in athletes who aren't very consistent in their training. If you're a "weekend warrior," make sure to stretch and strengthen your calf muscles appropriately and wear good, supportive shoes.

Degeneration can also cause the Achilles tendon to rupture. Degenerative changes break down and weaken the structure of the tendon, and this weakened tissue may tear easily.

Often used to treat bacterial infections, fluoroquinolone can lead to tendon rupture. This injury usually occurs shortly after this class of medication is started. Of the fluoroquinolones, levofloxacin is associated with the greatest risk of tendon rupture.

Symptoms of Achilles Tendon Rupture

When the Achilles does rupture, some people hear a "pop" or "snap" along with severe heel pain. This is so common, that many people feel as if someone kicked them in the back of the heel and they turn around to find that no one is behind them.

There may be a visible gap where the tendon is torn. Usually, with a tendon rupture, a person cannot walk or bear weight on their foot, although a small subset of people still can.

Self-Care

Self-care strategies can be used to treat Achilles tendonitis. They also may help in the immediate care of a possible Achilles tendon rupture.

The RICE Method

If you've got Achilles tendonitis, the RICE method can help you heal. Follow these treatment tips when symptoms first appear:

  • Rest: Take it easy and give your tendon a break by staying off it as much as you can. The more you use your tendon, the more likely you are to aggravate the injury.
  • Ice: Applying ice when the pain begins may help. It can also reduce swelling. You also may think about icing the tendon after exercise.
  • Compression: Using an elastic bandage to wrap the affected area can help reduce swelling. Make sure the wrap is snug, but not too tight that it cuts off your circulation.
  • Elevation: Elevating the injured leg can help reduce swelling. Try to keep it elevated above your heart. You can prop it on pillows when you're sitting or lying down.

For a suspected Achilles tendon rupture, place ice immediately on the injury site. Don't bear weight on the leg, and keep your leg elevated while you're on the way to the emergency room.

OTC Pain Relievers

For pain, consider over-the-counter (OTC) pain relievers. Common OTC pain relievers include acetaminophen (Tylenol), aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs).

Aspirin and NSAIDs will treat both pain and inflammation, while Tylenol treats only pain. If you're not sure which OTC pain reliever to take, talk to your healthcare provider about which one is best for you.

When to See a Healthcare Provider

It's important to seek out medical attention if you develop Achilles tendon pain. This may be pain in the back of your leg, anywhere from your heel to your calf.

In general, signs you may have injured your Achilles tendon include:

  • Achilles tendon pain
  • Pain down the back of your leg
  • Pain near your heel
  • A stiff, sore Achilles tendon when you first wake up
  • Achilles tendon pain after exercising
  • Achilles tendon pain that worsens throughout the day
  • Thickening of your tendon
  • Bone spurs on your heel bone
  • Difficulty flexing your foot and impaired range of motion
  • Sharp pain and a pop sound if the Achilles tendon ruptures

Other symptoms that warrant a healthcare provider visit include:

  • Leg or ankle stiffness or soreness
  • Swelling over the Achilles tendon
  • Difficulty standing on your tiptoes
  • Signs of an infection, like redness or warmth at the site

Some symptoms suggest a possible Achilles tendon rupture. They include sudden, severe pain at the back of the leg and/or trouble bearing weight on it. If that's the case, seek immediate medical care.

Diagnosis

A medical history and physical exam are needed to diagnose Achilles tendon pain. Your healthcare provider will also ask you questions about your symptoms and may order imaging tests.

An X-ray may be ordered to examine the bones. Injuries to the tendon can be identified with magnetic resonance imaging (MRI) or an ultrasound.

Physical Exam

A thorough physical exam of your foot and ankle can help determine the cause of your Achilles tendon pain.

Important elements of the exam include inspecting and pressing the area around the Achilles tendon. This is done to check for swelling, warmth, and tenderness. There may also be crepitus, a popping sound, or the ability to feel the tendon as it moves.

With Achilles tendinosis, there is pain when the site is touched. The tendon may feel thick, or there may be small bumps along it that signify fibrosis and scar tissue.

A healthcare provider can sometimes diagnose an Achilles tendon rupture by feeling the tendon because there may be a gap. Another clue for an Achilles rupture is bruising over the tendon. This is especially true if the blood extends beneath the malleolus, the bone that sticks out on each ankle.

Specific testing techniques can help identify Achilles tendon weakness or rupture. These include the Matles test and the Thompson test. You'll be lying face down for both of them. For the Matles test, you'll have your knees bent so your healthcare provider can assess plantar flexion (the same movement as when you point your toes). For the Thompson test, your legs will be straight and the provider will squeeze your calf muscle.

Imaging

Imaging for chronic Achilles tendon symptoms usually is done with an X-ray of the foot. This will help to identify any issues like bone spurs or degenerative damage, and it can identify a fracture. An ultrasound or an MRI is used to make or confirm a diagnosis of an Achilles tendon rupture.

Medical Treatments for Achilles Tendon Pain

After diagnosing your Achilles tendon pain, your healthcare provider may prescribe certain treatments, including immobilization, physical therapy, and, possibly, surgery. The key to healing and recovery is to stay on top of your care and follow your treatment plan from start to finish.

It can take at least two to three months for Achilles tendonitis to go away. It could take longer if you don't follow advice you are given about stretching, wearing orthotics, and limiting certain activities.

Support

Using ice and resting may help, but you also want to keep your tendon from moving around too much. Wrap your ankle with an elastic bandage or tape if you have Achilles tendonitis.

Splint

For a tendon rupture, an orthopedic surgeon will use a splint or other method to immobilize your ankle. If your injury is less severe, you may need just a splint. If your injury is more severe, you may be asked to wear a splint until you have surgery.

Orthotics

For both tendonitis and tendinosis, shoe orthotics can be used. They are meant to correct foot misalignments, such as flat feet, that may contribute to your tendon injury. Heel lift orthotics can reduce stress on the tendon and ease the pain for both tendonitis and tendinosis.

Surgery

An Achilles tendon rupture may need surgical repair within days of the injury. An orthopedic surgeon will suture (stitch) the two ends of the tendon back together.

Keep in mind that a partial tendon tear is sometimes treated like Achilles tendinosis. This may depend on your age, medical history, your normal level of activity, and how severe the tear is.

Partial tendon tears tend to be especially painful. If the tear is not treated with surgery, a controlled ankle motion (CAM) boot with a heel lift may be recommended. It will be used along with physical therapy or home exercises to prevent loss of muscle strength in the foot and ankle.

Surgery may be used in tendinosis to remove abnormal tissues and lesions, restore blood flow, and stimulate healing. The type of surgery will be based on the extent of the damage.

Physical Therapy

For Achilles tendonitis, it's a good idea to begin exercises that strengthen the calf muscle as soon as your healthcare provider thinks you're ready. Toe raises, balancing on your toes, and wall stretching are useful exercises.

Eccentric strength training, which works to lengthen muscles, is a popular and helpful therapy option. Eccentric exercises include heel raises with slowly lowering of the heel of the painful leg. Deep friction massage of the muscles that attach to the Achilles tendon is also helpful.

For Achilles tendinosis, you may need a special rehabilitation program. It's important to talk with your healthcare provider about programs that focus on slow, progressive, heavy-load exercise.

Instrument-assisted soft tissue mobilization (IASTM) is sometimes used to treat Achilles tendinosis. IASTM works by using an instrument to stimulate the body's inflammatory response. This prompts the body to produce new collagen protein to strengthen the tendon.

If you need surgery for an Achilles tendon rupture, physical therapy may be recommended afterward to help you regain full strength and endurance. Full recovery can take about four months.

Cortisone Shots

Corticosteroid injections are not recommended for Achilles tendon pain. Corticosteroids can weaken the Achilles tendon, making it more prone to tendonitis and rupture.

Preventing Achilles Tendon Pain

People tend to ignore early warning signs and push through the pain. If your Achilles tendon is sore or aches, you need to pay attention and rest it immediately.

Prevention is possible if you try some of these strategies. For example, night splints as recommended by your provider can help if you have Achilles tendonitis.

Stretching

Stretching before you exercise will help you to avoid Achilles tendon pain and injury. Some basic stretches include:

  • Achilles tendon stretch
  • Calf stretch
  • Plantar fascia stretch (Flexibility in the bottom of the foot can help with Achilles tendon health.)

Besides stretching, be sure you begin to exercise slowly. A proper warm-up will help you to safely ramp up the pace of your activity.

Strengthening

Some experts think that eccentric training may be able to help. It may strengthen the Achilles tendon, as well as the muscles it connects (the gastrocnemius and soleus muscles).

Other tips that may help to prevent an Achilles tendon injury include:

  • Always wear shoes that provide adequate cushioning for your heel and good arch support.
  • Avoid running on hard surfaces.
  • Avoid exercising outside in cold weather.

Summary

Inflammation that causes tendonitis is most common among athletes and results from repetitive stress. However, it can also stem from health conditions like obesity or a bone spur and, in rare cases, injury.

If tendonitis is not treated, you may develop the more serious and chronic condition of Achilles tendinosis. This degenerative condition can cause permanent changes. People with tendinosis may need a special rehabilitation program. They also may need to wear different shoes or make other lifestyle changes.

The sudden, severe pain of an Achilles tendon rupture requires immediate medical attention. A healthcare provider is likely to recommend surgery to repair the rupture as soon as possible. For any Achilles tendon pain, speak to a healthcare provider so that you can get the right diagnosis and treatment before the condition gets worse.

14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Lopez RG, Jung HG. Achilles tendinosis: treatment options. Clin Orthop Surg. 2015;7(1):1-7. doi:10.4055/cios.2015.7.1.1

  2. MedlinePlus. Achilles tendinitis.

  3. Tu P. Heel pain: diagnosis and managementAm Fam Physician. 2018;97(2):86-93.

  4. Fakoya AOJ, Otohinoyi DA, Fakoya FA. Correlation of some predisposing intrinsic conditions with the morphological integrity of the Achilles tendon. Ann Afr Med. 2018;17(2):58-63. doi:10.4103/aam.aam_49_17

  5. Shu Y, Zhang Q, He X, Liu Y, Wu P, Chen Li. Fluoroquinolone-associated suspected tendonitis and tendon rupture: a pharmacovigilance analysis from 2016 to 2021 based on the FAERS database. Front Pharmacol. 2022;13:990241. doi:10.3389/fphar.2022.990241

  6. Lopez RGL, Jung HG. Achilles tendinosis: treatment options. Clin Orthop Surg. 2015;7(1):1-7. doi:10.4055/cios.2015.7.1.1

  7. Egger AC, Berkowitz MJ. Achilles tendon injuries. Curr Rev Musculoskelet Med. 2017;10(1):72-80. doi:10.1007/s12178-017-9386-7

  8. Gulati V, Jaggard M, Al-Nammari SS, et al. Management of Achilles tendon injury: A current concepts systematic review. World J Orthop. 2015;6(4):380-386. doi:10.5312/wjo.v6.i4.380

  9. Center for Orthopaedic Surgery and Sports Medicine. What do you mean by RICE for tendonitis treatment.

  10. Cedars Sinai. Achilles tendon injuries.

  11. Penn Medicine. Achilles tendonitis.

  12. Park YH, Jeong SM, Choi GW, Kim HJ. How early must an acute Achilles tendon rupture be repaired? Injury. 2017;48(3):776-780. doi:10.1016/j.injury.2017.01.020

  13. Kim J, Sung DJ, Lee J. Therapeutic effectiveness of instrument-assisted soft tissue mobilization for soft tissue injury: mechanisms and practical applicationJ Exerc Rehabil. 2017;13(1):12-22. doi:10.12965/jer.1732824.412

  14. Jayaseelan DJ, Mischke JJ, Strazzulla RL. Eccentric exercise for Achilles tendinopathy: a narrative review and clinical decision-making considerations. J Funct Morphol Kinesiol. 2019;4(2):34. doi:10.3390/jfmk4020034

Additional Reading

By Elizabeth Quinn
Elizabeth Quinn is an exercise physiologist, sports medicine writer, and fitness consultant for corporate wellness and rehabilitation clinics.