Achilles Tendon Problems
What is the Achilles Tendon?
A tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon, the longest
tendon in the body, runs down the back of the lower leg and connects the calf muscle to the heel
bone. Also called the “heel cord,” the Achilles tendon facilitates walking by helping to raise the heel
off the ground.
Achilles Tendonitis and Achilles Tendonosis
Two common disorders that occur in the heel cord are Achilles tendonitis and Achilles tendonosis.
Achilles tendonitis can also be spelled Achilles tendinitis.
Achilles tendonitis is an inflammation of the Achilles tendon. This inflammation is typically short-
lived. Over time the condition usually progresses to a degeneration of the tendon, Achilles
tendonosis, in which the tendon loses its organized structure and is likely to develop microscopic
tears. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel
bone. In rare cases, chronic degeneration with or without pain may result in rupture of the tendon.
The symptoms associated with Achilles tendonitis and tendonosis include:
- There is pain, aching, stiffness, soreness, or tenderness within the tendon. This may occur
anywhere along the tendon’s path, beginning with the narrow area directly above the heel
and extending upward to the region just below the calf muscle. Often pain appears upon
arising in the morning or after periods of rest, then improves somewhat with motion. But later
worsens with increased activity.
- There is tenderness, or sometimes intense pain, when the sides of the tendon are
squeezed. There is less tenderness when pressing directly on the back of the tendon.
- When the disorder progresses to degeneration, the tendon may become enlarged and may
develop nodules in the area where the tissue is damaged.
As with “overuse” disorders, Achilles tendonitis and tendonosis are usually caused by a sudden
increase of a repetitive activity involving the Achilles tendon. Such activity puts too much stress on
the tendon too quickly, leading to micro-injury of the tendon fibers. Due to this ongoing stress on the
tendon, the body is unable to repair the injured tissue. The structure of the tendon is then altered,
resulting in continued pain.
Athletes are at high risk for developing disorders of the Achilles tendon. Achilles tendonitis and
tendonosis are also common in individuals whose work puts stress on their ankles and feet, such
as laborers, as well as in “weekend warriors”, those who are less conditioned and participate in
athletics only on weekends or infrequently.
People with excessive flattening of the arch (pronation) have a tendency to develop Achilles
tendonitis and tendonosis due to the greater demands placed on the tendon when walking. If these
individuals wear shoes without adequate stability, their over-pronation could further aggravate the
Treatment approaches for Achilles tendonitis or tendonosis are selected on the basis of how long
the injury has been present and the degree of damage to the tendon.
In the early stage, when there is acute inflammation, one or more of the following options may be
- Immobilization. Immobilization may involve the use of a cast or removable walking boot to
reduce forces through the Achilles tendon and promote healing.
- Ice. To reduce swelling due to inflammation, apply Zip Lock bag of ice over a thin towel to the
affected area for 20 minutes of each waking hour. Do not put ice directly against the skin.
- Oral medications. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may
be helpful in reducing the pain and inflammation in the early stage of the condition.
- Physical therapy. Physical therapy may include strengthening exercises, soft-tissue
massage/mobilization, gait and running re-education, stretching and ultrasound therapy.
- Orthotics. Foot orthotics will heel elevation relieves the stress on the tendon.
- If non-surgical approaches fail to restore the tendon to its normal condition, surgery may be
To prevent Achilles tendonitis or tendonosis from recurring after surgical or non-surgical treatment,
strengthening and stretching of the calf muscles through daily exercises may be recommended.
Wearing proper shoes for the foot type and activity is also important in preventing recurrence of the