What causes Achilles tendon pain?

By | March 28, 2019
The Achilles tendon connects the heel bone to the calf muscles at the back of the ankle. Pain in this tendon can result from a tear or rupture of the tendon or from tendinitis, which doctors may also refer to as tendinosis or tendinopathy.

The Achilles tendon is a bundle of strong fibers that support the calf and ankle during movement. Because the Achilles tendon is essential for walking, running, and jumping, it is very prone to wear and tear. Injuries to this tendon tend to be uncomfortable and can restrict a person’s movement.

In this article, we discuss the causes of Achilles tendon pain and when to see a doctor. We also cover diagnosis, treatment, and prevention.

Causes

The two main causes of Achilles tendon pain are a tear or rupture to to the tendon and tendinitis. We discuss both of these causes below:

Tear or rupture

man with achilles tendon pain
A tear or rupture can cause Achilles tendon pain.

It is possible for a person to tear the fibers of an Achilles tendon. This type of injury can either be:

  • a partial tear, where some of the fibers remain intact
  • a complete tear, where the tendon ruptures and all the fibers become disconnected

A tear or rupture is usually the result of excessive or repetitive stress on the ankle and feet. People who play sports that require rapid changes of pace or direction, such as tennis, football, and soccer, often incur injuries to the Achilles tendon.

These types of injury are also more likely when a person first starts a new sport or returns to an activity after a prolonged break. Sudden increases in exercise intensity can also lead to Achilles tendon injuries.

Symptoms of a tear or rupture can include:

  • a popping or snapping sound at the time of the injury
  • pain in the heel or back of the leg
  • pain that worsens when moving the ankle or foot
  • swelling around the heel
  • stiffness in the legs and heel
  • difficulty walking or moving the foot

Achilles tendinitis

Achilles tendinitis is a condition where the tendon becomes inflamed. There are two main types:

  • Noninsertional Achilles tendinitis. This is where the fibers in the middle of the tendon become inflamed. This condition is more common in younger people.
  • Insertional Achilles tendinitis. In this type, the inflammation affects the fibers in the lower tendon. It can occur in anyone but often results from intense physical activity over several years, such as long-distance running.

Both types of Achilles tendinitis typically result from overuse of the tendon, rather than from a specific injury. Tendinitis can develop gradually over time when a person regularly places too much strain on the tendon.

Risk factors for developing Achilles tendinitis can include:

  • sudden changes in a person’s activity levels or the intensity or type of activity
  • using inappropriate footwear, such as running in flat shoes
  • frequent or excessive activity
  • exercising on uneven surfaces
  • older age
  • being overweight
  • insufficient muscle strength in the lower legs
  • foot abnormalities, such as flat feet
  • taking fluoroquinolones, which are a type of antibiotic

Symptoms of Achilles tendinitis can include:

  • pain and stiffness in the ankle and legs
  • pain that worsens when moving the foot or ankle
  • swelling at the back of the ankle
  • bone spurs, which are bony growths near the heel bone

When to see a doctor

Partial tears of the Achilles tendon may not require medical treatment. If the symptoms are mild, the injury may heal itself with enough rest. However, it is advisable to see a doctor for severe pain or injuries that disrupt a person’s normal daily functioning.

People who notice a popping or snapping sound at the time of injury should see a doctor immediately.

Diagnosis

consultant looking at xray of foot and ankle
A doctor may request an X-ray to help make a diagnosis.

A doctor will typically begin by asking about symptoms and reviewing a person’s medical history. They will then usually perform a physical examination of the affected leg.

Symptoms of Achilles tendon problems can overlap with other types of injury, such as a sprained ankle, which can make it challenging for doctors to diagnose.

To help with their diagnosis, a doctor may recommend an X-ray or MRI scan. These tests create an image of the bones, ligaments, and tendons and allow the doctor to check for problems, such as tears or inflammation.

Treatment

Treatment for Achilles tendon pain depends on the type and severity of the injury.

For people with mild injuries, treatment typically involves:

  • resting the foot and ankle while the tendon heals
  • applying an icepack or cold compress on the tendon for up to 20 minutes several times a day
  • taking over-the-counter pain relievers, such as ibuprofen and acetaminophen

A doctor may also recommend physical therapy to help strengthen the calf muscle, reduce pressure on the tendon, and aid recovery.

For example, eccentric strength training is an effective way to treat Achilles tendon injuries. These exercises involve lengthening and tightening the Achilles tendon at the same time.

At first, it is important for a person to do these exercises with the help of a physical therapist. However, with practice, it may be possible to continue the exercises at home without supervision.

Wearing supportive footwear, such as specially-designed walking boots or orthopedic shoes, is another treatment option for Achilles tendon pain. It is also possible to adapt existing footwear by using heel lifts, for example.

Even with effective treatment, it can take between 3 and 6 months for symptoms to disappear.

If symptoms get worse or do not improve, a doctor may recommend surgery. A surgeon may lengthen the calf muscles or remove damaged parts of the tendon. The type of surgery will depend on the nature of a person’s injury.

Less commonly, a doctor may prescribe steroidal injections or extracorporeal shockwave therapy before recommending surgery. Research also shows that an injection of platelet-rich plasma can help improve healing in people with Achilles tendinopathy.

Prevention

group of young women doing warmup exercises before netball
Warming up before exercise can help reduce the risk of injury to the Achilles tendon.

Preventing an Achilles tendon pain is not always possible.

However, the following tips may help a person reduce the risk of injuring their Achilles tendon:

  • staying in good physical shape
  • avoiding sudden changes in exercise intensity or regime
  • building up exercise intensity gradually
  • warming up properly before exercising
  • wearing appropriate footwear
  • avoiding exercising or training on uneven surfaces or hard surfaces such as concrete

Summary

Causes of Achilles tendon pain include Achilles tendinitis and tears or ruptures to the tendon. These conditions are common in people who play sports and typically occur from excessive use of the calf muscles but can also result from acute injuries.

Factors that can increase a person’s risk of injuring an Achilles tendon include sudden changes in type or intensity of physical intensity, inappropriate footwear, or being overweight.

People who notice a popping or snapping sound at the time of the injury should seek immediate medical treatment. Also, see a doctor for severe or ongoing Achilles tendon pain.

Treatment options for Achilles injuries include rest and physical therapy. For people with more severe injuries, a doctor may recommend surgery.

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