Achilles tendonitis is an overuse injury caused by excessive mechanical loading of the tendon, leading to calf and posterior heel pain.
Achilles tendonitis is an overuse injury caused by excessive mechanical loading of the tendon, leading to calf and posterior heel pain. Symptoms are typically achy with occasional sharp pain that worsens with activity or pressure, most commonly affecting the midportion of the tendon but sometimes the insertion on the calcaneus. Management is usually nonsurgical and includes activity modification, physical therapy, analgesics, and orthotics.
Achilles tendon pathology is primarily characterized by a failed healing response resulting in tendon degeneration rather than true inflammation. Patients typically report posterior heel pain with associated swelling, burning, and reduced mobility, often worsening with activity such as exercise or stair climbing. In acute cases, inflammation occurs within the tendon sheath leading to edema and impaired circulation.
Chronic tendon degeneration involves disorganized collagen fibers, increased blood vessel growth into the tendon, and a failed healing response. Insertional Achilles tendinopathy affects where the tendon attaches to the heel bone and is often made worse by bone irritation at the back of the heel. Risk factors include sudden increases in training, tight calf muscles, worn-out footwear, running on hard surfaces, and age-related tendon changes.
Nonsurgical treatment is effective for the vast majority of patients. This includes activity modification, eccentric calf strengthening exercises, physical therapy, heel lifts or custom orthotics, and anti-inflammatory medications. For persistent cases, treatments such as shockwave therapy, PRP injections, and ultrasound-guided procedures may be considered.
Most patients improve significantly within 3 to 6 months of consistent treatment. Eccentric strengthening exercises are the most evidence-supported intervention for non-insertional disease. A gradual return to activity is recommended, and patience is important as tendons heal slowly.
If you are experiencing posterior heel or calf pain that does not improve with rest, or if you felt a sudden pop in the back of your ankle, see a sports medicine physician promptly. Early evaluation and treatment lead to better outcomes and help prevent progression to a complete tendon rupture.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
Connect with a doctor, physical therapist, or imaging center near you.
Find a Provider Near You โ