Achilles tendonitis is overload of the Achilles tendon, the thickest tendon in the body, which joins the calf to the heel. Achilles tendon pain is usually felt a few centimetres above the heel, or right where the tendon attaches to the bone. It is most common in runners and in people between 30 and 60 who have suddenly increased their training. People also call it inflammation of the Achilles tendon. When the pain has lasted longer, though, it is more about wear than inflammation.
Symptoms
- Pain and stiffness in the tendon in the morning, with the first steps.
- Pain at the start of a run that eases as you warm up and comes back afterwards.
- A thickening or lump in the tendon.
- Tenderness when you press the tendon with your fingers.
- Pain going up stairs or rising onto your toes.
- If the pain is where the tendon attaches: the shoe presses on the back of the heel.
The pain usually builds up over weeks. It is typically at its worst the morning after exercise, not during the run itself. That is why morning stiffness is a good guide to whether you did too much. If it hurts only at the back of the heel, shoes with a stiff back make it worse.
Why it happens
- A sudden increase in running, especially uphill or at speed.
- Stiff, weak calves.
- Running on hard or sloping surfaces.
- Changing shoes, especially to a lower heel.
- Flat feet, or a foot that rolls inwards.
- Age, being overweight and some conditions, such as diabetes.
A tendon gets used to load slowly, over weeks and months. Muscles get stronger faster, so with a new training programme the tendon often falls behind and becomes overloaded.
How we treat it
Kaloyan checks the tendon, the strength and flexibility of your calf, and how you walk. Bring the trainers you run in: the wear on the soles shows how your foot meets the ground. The core of the treatment is exercises that load the tendon gradually, which Kaloyan introduces step by step. The first ones are usually static, holding yourself up on your toes without moving, and then they become dynamic and heavier. Ultrasound therapy helps the irritated tendon at the start. TECAR therapy warms the calf and the tendon and reduces stiffness, especially if the pain has lasted for months.
Kinesio taping takes the load off the tendon when you walk and when you return to running. Tendons recover slowly, so treatment usually takes about 2 months, with visits getting further apart over time. You don’t always have to stop running completely: Kaloyan tells you how much you can run without making the pain worse. If the pain is right at the heel, where the tendon attaches, the exercises are a little different and Kaloyan will tell you which movements to avoid.
What you can do yourself
- Cut down your running, especially uphill and at speed, but don’t stop moving altogether.
- Wear shoes with a slightly raised heel until the pain eases.
- Don’t stretch the tendon hard, and don’t massage the painful lump yourself.
- Keep an eye on morning stiffness: if it gets worse, reduce the load.
- When you go back to running, build up gradually and start on flat ground.
- Warm up your calves before a run with some slow walking.
When to see a doctor first
See a doctor first if:
- you heard a snap or felt a blow to the heel and afterwards can’t rise onto your toes;
- the tendon is badly swollen, red and warm;
- both heels hurt and you also have pain in other joints;
- the pain doesn’t ease after several weeks’ rest from running.
