Achilles Tendonitis Care and Treatment

What You Need To Know

Understanding Achilles tendonitis and how we help you recover from heel cord pain.

Understanding Achilles Tendonitis

Achilles tendinopathy is a broad term describing conditions that cause pain, swelling, and stiffness to the Achilles tendon, a large tendon that attaches to the back of your heel bone. One classic symptom is pain and stiffness during your first couple of steps in the morning. These symptoms may resolve within 15 minutes but return throughout the day with increased walking, and at night or after strenuous activity the pain can be debilitating.

Achilles tendinitis is inflammation of the tendon and is typically short-lived. If not resolved, the condition may progress to Achilles tendinosis, a degeneration in which the tendon loses its organized structure and develops microscopic tears and thickening. As the disorder progresses, the tendon may become enlarged and develop firm nodules where tissue is damaged.

These conditions are usually caused by a sudden increase or repetitive activity involving the Achilles tendon. Athletes, manual laborers, and people with excessively pronated or flat feet are at higher risk. Much of the Achilles tendon does not have a direct blood supply, which makes healing more difficult.

In diagnosing Achilles tendinitis or tendinosis, our doctors will examine your foot and ankle and evaluate the range of motion and condition of the tendon. The area can be further assessed with X-rays, ultrasound, or MRI. If you are experiencing persistent heel cord pain, we encourage you to schedule an evaluation so treatment can begin before the tendon degenerates further.

Treatment and Prevention Options

Treatment for Achilles tendinitis or tendinosis is selected based on how long the injury has been present and the degree of damage to the tendon. In the early stage, when there is sudden inflammation, we often recommend immobilization with a cast, posterior splint, or removable walking boot to reduce forces through the tendon and promote healing.

Additional conservative options include applying ice for 20 minutes each waking hour, using NSAIDs such as ibuprofen for pain and inflammation, and prescribing custom orthotic devices for patients with overpronation or gait abnormalities. Night splints help maintain a stretch in the tendon during sleep, and physical therapy may include strengthening exercises, soft-tissue massage, gait re-education, stretching, and ultrasound therapy.

Unless there is a rupture present, we tend to avoid surgery of the Achilles tendon. Less invasive techniques can often improve tendinosis without a larger incision to open up the tendon for repair. If pain persists after conservative care, surgical intervention may be necessary, and the doctor will select the best procedure based on the extent of the injury, your age, and your activity level.

To prevent recurrence, we may recommend strengthening and stretching exercises to build tendon load capacity and improve flexibility of the tendon, calf, and hamstring muscles. With the right combination of rest, therapy, and proper footwear, most patients return to the activities they love without ongoing heel pain.