By Dr. Gary Feldman, DPM, FACFAS
Podiatric Medicine & Surgery
Maryland Orthopedic Specialists | The Centers for Advanced Orthopaedics
Published March 16, 2026
If you’re a runner, a weekend basketball player, or someone who simply stays active, you’ve probably felt that familiar tightness or soreness at the back of your ankle at some point. In my practice, Achilles tendon problems are among the most common complaints I see — and for good reason. The Achilles tendon is the thickest and strongest tendon in the human body, yet it is also one of the most frequently injured, particularly in active adults.
Whether you’re dealing with a nagging ache that won’t go away or you’ve experienced that dreaded “pop” during a pickup game, understanding what’s happening to your Achilles tendon is the first step toward getting better. This article walks through the spectrum of Achilles tendon injuries — from chronic overuse to acute rupture — and what can be done about them.
What the Achilles Tendon Does — and Why It’s Vulnerable
The Achilles tendon connects your calf muscles (the gastrocnemius and soleus) to your heel bone (calcaneus). Every time you walk, run, jump, or push off the ground, your Achilles tendon bears tremendous force — up to 6 to 8 times your body weight during running. Despite its remarkable strength, this tendon has a relatively poor blood supply in its midsection, roughly 2 to 6 centimeters above the heel. This “watershed zone” makes it particularly susceptible to degeneration and injury over time.
Achilles tendon disorders affect approximately 6% of the general population at some point in their lifetime, and the incidence has been climbing in recent decades as more people engage in recreational sports and fitness activities. Among runners, Achilles tendinopathy is one of the most prevalent overuse injuries, with the highest rates seen in runners, track and field athletes, and players of volleyball, tennis, and soccer.
Achilles Tendinopathy: When Overuse Takes Its Toll
Achilles tendinopathy — the clinical term for chronic Achilles tendon pain and dysfunction — is not truly an inflammatory condition. It is better understood as a failed healing response, where the tendon’s normal repair mechanisms are overwhelmed by repetitive microtrauma. This distinction is important because it guides treatment.
Who Is at Risk?
Several factors increase the risk for Achilles tendinopathy:
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Training errors such as sudden increases in mileage, intensity, or hill running
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Age, most commonly affecting adults aged 30 to 50
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Sex, with higher prevalence in men
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Higher body weight increasing tendon load
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Foot biomechanics including flat feet, overpronation, or poor ankle flexibility
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Worn-out or unsupportive footwear
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Medications such as fluoroquinolone antibiotics and systemic corticosteroids
What Does It Feel Like?
Patients typically describe a gradual onset of stiffness and pain at the back of the ankle, often worse first thing in the morning or at the start of exercise. The pain may improve with gentle activity but returns after rest. Thickening or a tender nodule along the tendon may also be present. Achilles tendinopathy can be classified as either insertional (at the heel bone attachment) or midportion (in the watershed zone), and this distinction affects treatment.
How We Treat Tendinopathy
The cornerstone of management is progressive tendon loading rather than rest alone. A comprehensive treatment plan includes:
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Activity modification with temporary reduction of high-impact activities while maintaining fitness
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Eccentric exercise programs, which involve controlled lowering of the heel and remain the most effective first-line treatment
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Physical therapy to address calf weakness, ankle stiffness, and biomechanical contributors
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Proper footwear and orthotics to reduce tendon strain
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Adjunctive therapies such as extracorporeal shockwave therapy and, in select cases, platelet-rich plasma injections
Most patients improve with a structured conservative program, though recovery requires patience and may take weeks to months. If symptoms persist after 3 to 6 months, surgical options such as debridement or repair may be considered.
Achilles Tendon Rupture: When the Tendon Gives Way
An acute Achilles tendon rupture is a sudden, complete or near-complete tear of the tendon. Patients often describe the sensation as being “kicked in the back of the leg” or hearing a pop. These injuries most commonly occur in men aged 30 to 50 during recreational sports such as basketball, tennis, soccer, and running.
Studies of professional athletes show that these injuries are typically noncontact and occur during push-off movements. Recovery can be prolonged, and return to activity often takes many months.
Surgery vs. Conservative Treatment
Treatment for acute Achilles rupture can be either surgical or nonoperative. Research shows that patient outcomes at one year are similar between approaches. However, nonoperative treatment carries a slightly higher risk of rerupture, while surgery carries a higher risk of complications such as infection or nerve injury.
When early functional rehabilitation is used, nonoperative outcomes improve significantly. Treatment decisions should be individualized:
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Younger, highly active patients may benefit from surgical repair to reduce rerupture risk
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Patients with lower activity demands or medical comorbidities often do well with nonoperative care
Prevention: Protecting Your Achilles Tendon
To reduce the risk of injury:
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Progress training gradually, increasing volume by no more than 10% per week
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Strengthen the calf muscles with regular exercises
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Perform gentle calf stretching after activity
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Wear appropriate footwear and replace running shoes regularly
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Seek evaluation for persistent pain
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When to See a Specialist
If Achilles pain persists beyond two to three weeks, worsens despite rest, or is associated with a sudden pop or difficulty pushing off, medical evaluation is recommended. Early diagnosis and treatment can significantly improve outcomes.
At Maryland Orthopedic Specialists, our team works closely with in-house physical therapists to develop personalized treatment plans. To schedule a consultation, call (301) 515-0900 or visit www.mdorthospecialists.com.
This document is intended for patient education purposes only and does not constitute medical advice. Patients should consult their physician for individualized recommendations.
References
Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. British Journal of Sports Medicine. 2007;41(4):211-216.
Fan L, Hu Y, Zhou L, Fu W. Surgical vs. nonoperative treatment for acute Achilles tendon rupture: a meta-analysis of randomized controlled trials. Frontiers in Surgery. 2024;11:1483584.
Lemme NJ, Li NY, DeFroda SF, Kleiner J, Owens BD. Epidemiology and video analysis of Achilles tendon ruptures in the National Basketball Association. American Journal of Sports Medicine. 2019;47(11):2650-2656.
Myhrvold SB, Brouwer EF, Andresen TK, et al. Nonoperative or surgical treatment of acute Achilles tendon rupture. New England Journal of Medicine. 2022;386(15):1409-1420.
Prudêncio DA, Maffulli N, Migliorini F, et al. Eccentric exercise in the treatment of mid-portion Achilles tendinopathy: systematic review and meta-analysis. BMC Sports Science, Medicine and Rehabilitation. 2023;15:18.
Soroceanu A, Sidhwa F, Aarabi S, Kaufman A, Glazebrook M. Surgical versus nonsurgical treatment of acute Achilles tendon rupture. Journal of Bone and Joint Surgery. 2012;94(23):2136-2143.
Tarantino D, Mottola R, Resta G, et al. Achilles tendinopathy pathogenesis and management: a narrative review. International Journal of Environmental Research and Public Health. 2023;20(17):6681.
van der Vlist AC, Weir A, Ardern CL, et al. Treatment effectiveness for Achilles tendinopathy: systematic review with network meta-analysis. British Journal of Sports Medicine. 2021;55(5):249-256.
Vlahovich N, Hughes DC, Ashton KJ, Kozlovskaia M, Macgregor S. Biomedical risk factors of Achilles tendinopathy in physically active people. Sports Medicine Open. 2017;3:20.
