Tendinitis of the heel; Heel pain - Achilles
Achilles tendinitis occurs when the tendon that connects the back of your leg to your heel becomes swollen and painful near the bottom of the foot. This tendon is called the Achilles tendon. It allows you to push your foot down. You use your Achilles tendon when walking, running, and jumping.
There are two large muscles in the calf. These create the power needed to push off with the foot or go up on the toes. The large Achilles tendon connects these muscles to the heel.
Heel pain is most often due to overuse of the foot. Rarely, it is caused by an injury.
Tendinitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.
Achilles tendinitis may be more likely to occur if:
Tendinitis from arthritis is more common in middle-aged and older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling. Flat feet will put more tension on the tendon.
Symptoms include pain in the heel and along the length of the tendon when walking or running. The area may feel painful and stiff in the morning.
The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on your toes. You may also have trouble finding shoes that fit comfortably due to pain in the back of your heel.
The health care provider will perform a physical exam. They will look for tenderness along the tendon and pain in the area of the tendon when you stand on your toes.
X-rays can help diagnose bone problems.
An MRI scan of the foot may be done if you are considering surgery or there is a chance that you have a tear in the Achilles tendon.
The main treatments for Achilles tendinitis do not involve surgery. It is important to remember that it may take at least 2 to 3 months for the pain to go away.
Try putting ice on the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the area gets numb.
Changes in activity may help manage the symptoms:
Your provider or physical therapist can show you stretching exercises or eccentric loading exercises for the Achilles tendon.
You may also need to make changes in your footwear, such as:
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, can help ease pain or swelling.
Other treatment include injections, such as platelet rich plasma or steroids, to reduce the inflammation. However, the tendon can become even weaker following injection and should be protected after the injections.
If these treatments do not improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur.
Extracorporeal shock wave therapy (ESWT) may be an alternative to surgery for people who have not responded to other treatments. This treatment uses low-dose sound waves.
In most cases, lifestyle changes help improve symptoms. Keep in mind that symptoms may return if you do not limit activities that cause pain, or if you do not maintain the strength and flexibility of the tendon.
Achilles tendinitis may make you more likely to have an Achilles rupture. This condition most often causes a sharp pain that feels as if you have been hit in the back of the heel with a stick. Surgical repair is often necessary. However, the surgery may not be as successful as usual because there is already damage to the tendon.
Contact your provider if:
Exercises to keep your calf muscles strong and flexible will help reduce the risk for tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis.
Biundo JJ. Bursitis, tendinitis, and other periarticular disorders and sports medicine. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 247.
Brotzman SB. Achilles tendinopathy. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 44.
Hogrefe C, Jones EM. Tendinopathy and bursitis. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 103.
Waldman SD. Achilles tendinitis. In: Waldman SD, ed. Atlas of Common Pain Syndromes. 4th ed. Philadelphia, PA: Elsevier; 2019:chap 126.BACK TO TOP
Review Date: 9/20/2022
Reviewed By: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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