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Achilles Tendonitits Causes, Symptoms & Treatment Options

Achilles tendonitis is a common condition among athletes. It occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed either due to an acute injury or, more commonly, with overuse.

Achilles Tendonitits Hero Image 2

Achilles tendonitis is a common condition among athletes. It occurs when the large tendon that runs down the back of your lower leg becomes irritated and inflamed either due to an acute injury or, more commonly, with overuse. The Achilles tendon is the largest tendon in the body and connects the calf muscles to the heel. The tendon is used for push-off strength, balance, and power while standing, walking, running, and jumping. Inflammation of the tendon can occur at the junction between the muscle and tendon, at the tendon itself, or at its attachment to the heel bone.

What causes Achilles Tendonitits?

Rather than a single injury, Achilles tendonitis is usually caused by long term repetitive use of the tendon. Athletes who only exercise sporadically or don’t warm up properly are particularly at risk, especially if they exercise too intensely and without adequate rest to recover in between. Older athletes are at greater risk, as the Achilles tendon degenerates with age. The injury is more common in athletes who play sports that involve quick stops and changes in direction.

Achilles tendon injuries are most common in these sports:

  • Tennis
  • Basketball
  • Running
  • Soccer
  • Bicycling
  • Hiking


The common symptom associated with Achilles tendonitis is pain in the back of the leg or ankle, especially in the morning. Pain often worsens with activity. Common symptoms also include:

  • Swelling in the back of the leg or ankle
  • Tenderness
  • Thickening of the tendon
  • Stiffness with stretching when “starting up” after sitting or sleeping
  • Severe pain the day after exercising

Achilles Tendonitis

When to see a doctor

If you have pain in the Achilles tendon area that doesn’t get better, you should see a doctor. If the pain is severe and you have trouble walking, you should seek emergency care, as you may have a ruptured tendon. At your visit, your doctor will ask questions about your symptoms and physical activity. A physical examination will be conducted to look for swelling, areas of tenderness, and thickening of the tendon. You may be asked to stand on the balls of your toes to test your strength. Your doctor may also order imaging tests, such as an x-ray or magnetic resonance imaging (MRI) test, to help confirm the diagnosis.

Non-operative treatment

Non-surgical treatments are usually effective in resolving symptoms associated with Achilles tendonitis, though they may take a few months. Conservative treatments may include:

  • Rest from sports that are painful
  • Switching to less strenuous activities that are easier on your Achilles tendon
  • Applying ice to the affected area for 20 minute intervals to reduce inflammation; alternating icing with a heat pad may be helpful
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, to relieve pain
  • Night splinting to allow the tendon to heal at the proper length
  • Gentle stretching of your calf muscle
  • Physical therapy exercises to stretch and strengthen the calf muscles

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Achilles Tendonitis

Surgical Treatment

If Achilles tendonitis doesn’t improve with conservative treatment after several months, your doctor may refer you to an orthopedic surgeon. Surgery may be needed to remove scar tissue, repair the damaged tendon, extend the calf muscle, or address other issues identified by your doctor.


Recovery from Achilles tendonitis will vary depending upon the extent of damage to the tendon. For some athletes, tendonitis will resolve in a matter of days with treatment. For others, a much longer recovery time will be required before they can return to play. Physical therapy will be an important part of the rehabilitation process.


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