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Achilles Tendon Injury

The Achilles tendon is the largest tendon in the body and connects your calf muscles to your heel bones. Achilles tendinitis is an inflammation of that tendon, and inflammation is your body’s natural response to injury and often causes swelling, pain, and irritation. When your Achilles tendon is inflamed or irritated, your ability to walk, run, climb stairs, jump, and stand on your tiptoes becomes difficult and painful.

What causes it?

Excessive exercise or walking commonly causes Achilles tendinitis, especially for athletes. Rheumatoid arthritis and infection are also linked to tendinitis. Some causes include:

  • Exercising without a proper warmup
  • Straining the calf muscles during repeated exercise or physical activity
  • Playing sports, such as tennis, that require quick stops and changes of direction
  • Wearing old or poor-fitting shoes
  • Wearing high heels daily or for prolonged durations

How do you know you have it?

You might have Achilles tendinitis if you experience:

  • Pain and stiffness in the Achilles area in the morning or that worsens with activity
  • Severe pain the day after exercising
  • Bone spurs on the back of your heel and thickening of the tendon
  • Constant swelling that gets worse throughout the day and with activity

If you have experienced a sudden “pop” in your calf or heel, you may have ruptured your Achilles tendon and should call us immediately.

The type of tendinitis you’re experiencing depends on which part of the tendon is inflamed.

Noninsertional Achilles Tendinitis

With noninsertional Achilles tendinitis, fibers in the middle portion of the tendon have started to break down and develop tiny tears, swell, and thicken. This type typically affects younger, active people.

Insertional Achilles Tendinitis

The lower portion of the heel, where the tendon attaches to the heel bone, is affected by insertional Achilles tendinitis. Damaged tendon fibers can calcify, and bone spurs often form with this type of Achilles tendinitis. It can occur at any time, even if you are not active. However, it is common in long-distance runners and sprinters and typically comes from years of overuse.

How we fix it

The OSI foot and ankle team is here to listen, discuss your concerns, and examine you for signs and symptoms of Achilles tendinitis. Our goal is to have you back on your feet, pain free, enjoying the activities you love. While you’re under our expert care, you may undergo the following tests to determine the best course of care:

  • X-rays: An x-ray will show whether the lower part of the tendon has calcified. In severe cases, the middle part of the tendon may have calcified, as well.
  • MRI: Magnetic resonance imaging isn’t necessary to diagnose Achilles tendinitis, but it is important for planning surgery. It will show the severity of the damage, which will help our doctors select the proper procedure.

Nonsurgical Treatment

Most of the time nonsurgical treatment will provide pain relief, though it may take months for your symptoms to completely subside. The longer you’ve been experiencing symptoms, the longer they take to go away.

  • This is the first step in reducing pain. Switch to low-impact activities like biking, elliptical exercise, and swimming to help you stay active while you heal.
  • Apply ice to the most painful spot for up to 20 minutes at a time, making sure to stop sooner if your skin becomes numb, throughout the day.
  • Non-steroidal anti-inflammatory medication. Ibuprofen and naproxen reduce pain and swelling, but they will not reduce thickening of your tendon. Consult with us before beginning long-term use of NSAIDs.
  • A simple calf stretch can help strengthen the calf muscles and reduce stress on the tendon.
  • Physical therapy. PT has a proven track record, but it does work better to treat noninsertional tendinitis versus insertional tendinitis. Your physical therapist will give you exercises you can perform at home.
  • Supportive shoes and orthotics. Certain shoes and orthotics can help reduce pain related to insertional Achilles tendinitis, and our caring team will be able to recommend the type that will work best for you. If you have severe pain, a walking boot may be recommended for a short time so your tendon can rest before any therapy begins.
  • Extracorporeal shockwave therapy (ESWT). This procedure uses high-energy shock waves to stimulate the healing process in damaged tendon tissue. It’s not always effective, but it is sometimes considered before surgery is considered.

Surgical Treatment

If pain has not subsided after 6 months of nonsurgical treatment, your OSI team may recommend surgery. The options will vary based on the type of tendinitis and the amount of damage, and these will be discussed in detail with your doctor. Surgical options are:

  • Gastrocnemius recession
  • Débridement and repair
  • Débridement with tendon transfer


Most OSI patients experience positive results after surgery, and the main contributing factor is the amount of damage to the tendon. Physical therapy is an important part of recovery, and you may require up to 12 months of rehab before you are pain free.