Achilles Trouble?

What is the Achilles tendon? Why does it hurt? What can I do to fix it? All good questions!

A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon is the longest tendon in the body and runs down the back of the lower leg and connects the calf muscle to the heel bone. The Achilles tendon helps you walk by raising the heel off the ground.

Common Achilles Troubles:

Two common disorders that occurred in the Achilles tendon are tendonitis and tendonosis. 

Achilles tendonitis is an inflammation of the tendon that is typically short in duration. If this inflammation persists and progresses, over time the tendon starts to degenerate and tendonosis occurs. Tendonosis is when the tendon loses its organized structure and is likely to develop microscopic tears and even rupture. 


The symptoms associated with Achilles tendonitis and tendonosis include:

Pain: aching, stiffness, soreness and tenderness within the tendon, especially when palpated. This may occur anywhere along the tendons path from the insertion on the heel to the muscle belly that is attached in the calf.  Pain is usually worse in the morning or after periods of rest and may warm-up or get better with increased activity.

Enlargement of the tendon: A nodule may form in the area where the tendon is degenerated and swelling will go up and down with activity.


The cause of Achilles tendonitis and tendonosis is usually a sudden increase a repetitive activity that includes the tendon. Think too much, too soon, and too fast. These activities put too much stress on the tendon too quickly leading to micro injury to the tendon fibers. Due to this ongoing stress to the tendon, the body is unable to repair the injured tissue and this leads to the formation of tendonitis.

Athletes are at the highest risk of developing disorders of the Achilles tendon; but it is also common in patients who work on their feet and ankles such as laborers, waitresses, factory workers, nurses and anyone who spends a lot of time standing or pushing and pulling objects with their feet. People with excessively flat feet are a higher risk due to the increased demand on the tendon while walking. It is also true that people with a very high arches are at higher risk of Achilles issues due to having very tight calf muscles which causes excessive stress to the Achilles tendon.


Diagnosis of Achilles tendonitis and tendonosis is made by physical exam, x-rays to determine if any spurring is involved, and possibly a diagnostic ultrasound or MRI to determine the extent of damage to the tendon.


Treatment of Achilles tendon disorders are based on how long the injury has been present and the degree of damage to the tendon.

Early treatments are focused on decreasing acute inflammation with ice, anti-inflammatories, gentle stretching, and possibly immobilization and physical therapy. Often a night splint and arch supports or orthotics coupled with better shoe gear are necessary to control tendonitis.

If conservative therapy is unable to resolve tendon issues, surgery may be necessary. This may include stem cell or PRP injections, debridement of damaged tendon, removal of spurring and repair of the remaining tendon.

When it comes to treatment of Achilles tendon pain, the earlier treatment equals faster and better outcomes. If you are experiencing Achilles tendon problems, please visit your favorite podiatrist. Early diagnosis and treatment are the best options to get you back to running, jumping, and playing with the other kids.