Achilles Tendonitis: Understanding the Condition and Managing Your Recovery
The Achilles Tendon and How It Gets Injured
The Achilles tendon is the thickest and strongest tendon in the body. It connects the gastrocnemius and soleus muscles of the calf to the calcaneus (heel bone), transmitting the force your calf generates into forward propulsion with every step. Because it bears loads up to several times your body weight during running and jumping, it is also one of the tendons most susceptible to overuse injury.
Achilles tendonitis — more precisely called Achilles tendinopathy when the condition becomes chronic — involves degenerative changes within the tendon substance rather than true acute inflammation. Two anatomic subtypes are recognized. Non-insertional tendinopathy affects the mid-portion of the tendon, roughly 2–6 centimeters above the heel, and is more common in runners and younger active individuals. Insertional tendinopathy involves the point where the tendon attaches to the heel bone and often occurs alongside bone spur formation; it is more prevalent in older or heavier patients.
Risk factors include a sudden increase in training volume or intensity, tight calf muscles, flat feet or high arches, inadequate footwear, and training on hard surfaces. Age-related tendon stiffening also contributes.
Symptoms to Recognize
Pain and stiffness at the back of the heel or lower calf — particularly with the first steps in the morning or after prolonged sitting — is the most consistent presenting complaint. The discomfort typically improves with a few minutes of walking but worsens again with sustained or intense activity. Localized swelling and tenderness over the tendon are common. You may notice a nodule within the mid-tendon substance in non-insertional cases.
If the pain is sudden, severe, and accompanied by a sensation of being struck in the calf, consider the possibility of a complete tendon rupture, which requires immediate evaluation.
Evidence-Based Treatment Strategies
Eccentric exercise is the best-supported rehabilitation intervention for Achilles tendinopathy. Eccentric heel drops — standing on the edge of a step, raising onto the toes with both feet, and then lowering slowly with the affected leg alone — load the tendon in a lengthening phase and have been shown in multiple studies to reduce pain and improve function. A standard protocol involves three sets of 15 repetitions twice daily for 12 weeks. Initial soreness during the exercises is expected and does not mean you should stop.
Load management is equally important. This does not mean complete rest — tendon tissue remodels in response to load and actually deteriorates with prolonged immobilization. Instead, reduce the activities that provoke peak pain (sprinting, hill running, jumping) while maintaining lower-impact movement such as swimming or cycling.
Footwear and orthotics play a supporting role. A small heel lift temporarily reduces tension on the Achilles by decreasing the angle the tendon must traverse. Supportive shoes with adequate heel cushioning reduce impact loading. Custom orthotics are indicated if significant biomechanical abnormalities — such as overpronation — are contributing to the problem.
Extracorporeal shockwave therapy (ESWT) delivers acoustic energy to the tendon, stimulating a healing response. It is an effective option for patients who have not responded to a structured exercise program, particularly in the insertional subtype.
Corticosteroid injections are generally avoided directly into the tendon body due to the risk of tendon weakening and rupture. Peritendinous injections (around, not into, the tendon) may be considered to reduce surrounding inflammation in carefully selected cases.
Surgery — including debridement of degenerated tissue or reattachment of the tendon at its insertion — is reserved for patients who have completed at least six months of well-supervised conservative treatment without adequate improvement.
When to See a Specialist
If pain persists beyond six to eight weeks of consistent home management, or if symptoms are severe enough to significantly limit walking, schedule an evaluation. Imaging with ultrasound or MRI can confirm the diagnosis, identify the extent of tendon changes, and rule out partial rupture.
If you're experiencing heel or calf pain that hasn't improved with rest, the specialists at Maryland Orthopedic Specialists can help. Call (301) 515-0900 or [schedule an appointment online](https://www.mdorthospecialists.com/contact).
