Achilles Tendonitis

Achilles tendonitis is an overuse injury that occurs when the Achilles tendon, the largest and strongest tendon in your body connecting the calf muscles to the heel, becomes irritated and inflamed from repetitive stress. This condition is common in active adults and runners, and can progress to tendon degeneration (tendinosis) or rupture if left untreated.

According to the American Academy of Orthopaedic Surgeons, Achilles tendonitis is one of the most common running injuries. At Mountain Spine & Orthopedics, our foot and ankle specialists provide comprehensive treatment plans to calm inflammation, rebuild strength, and protect you from future injury—including potential Achilles tendon rupture.

Symptoms of Achilles tendonitis develop gradually and worsen over time if not addressed.

• Pain and stiffness along the back of the Achilles tendon, especially in the morning
• Pain that worsens with activity and improves with rest
• Swelling or tenderness at the back of the heel
• Thickening of the tendon ("cord-like" feeling)
• Limited ankle flexibility—difficulty flexing the foot
• Creaking or crackling sensation with movement
• Pain when rising on tiptoes or climbing stairs

• Sudden activity increase: Rapidly increasing training intensity or duration
• Tight calf muscles: Increase strain on the tendon
• Improper footwear: Worn-out shoes or inadequate heel support
• Foot structure: Flat feet or overpronation
• Bone spurs: Heel spurs can irritate the tendon
• Age: Tendon flexibility decreases with age
• Running on hills: Increases tendon stress
• Fluoroquinolone antibiotics: Associated with tendon damage

Diagnosis involves a physical exam where our specialist assesses the tendon for pain, swelling, and thickening. We perform specific tests to evaluate tendon integrity and rule out rupture.

We may use a complimentary ultrasound or MRI review to assess the extent of tendon damage or degeneration and differentiate between insertional and mid-substance tendonitis, which require different treatment approaches.

Treatment focuses on reducing inflammation, promoting healing, and addressing underlying causes.

Non-Surgical Treatment

• RICE protocol: Rest, Ice, Compression, Elevation
• Eccentric exercises: Heel drops and calf stretches (proven most effective)
• Orthotics: Heel lifts and arch supports reduce tendon strain
• Physical therapy: Strengthening and flexibility program
• NSAIDs: Short-term use for inflammation
• Night splints: Maintain stretch while sleeping

Interventional Options

• PRP injections: Platelet-rich plasma promotes tissue healing
• ESWT: Extracorporeal shockwave therapy stimulates repair

Surgical Treatment

For severe cases or complete rupture, Achilles tendon repair surgery may be necessary.

Pain from Achilles tendonitis is typically felt along the back of the lower leg, near the heel. It often begins as a mild ache after activity and can gradually worsen to more severe, burning pain. Morning pain and stiffness are characteristic—the tendon tightens overnight and is suddenly stretched with first steps.

Smart training habits and proper footwear are your best defenses against Achilles tendon problems.

• Increase activity gradually: Follow the 10% rule for training increases
• Warm up properly: Dynamic stretching before exercise
• Stretch regularly: Calf and Achilles stretches daily
• Strengthen calf muscles: Eccentric exercises build tendon resilience
• Wear proper footwear: Supportive shoes with adequate heel cushioning
• Replace worn shoes: Every 300-500 miles for runners
• Vary your training: Cross-train to reduce repetitive stress
• Address foot problems: Use orthotics for flat feet or pronation

If ongoing Achilles tendon pain is limiting your activities, contact Mountain Spine & Orthopedics to arrange a consultation. We provide thorough diagnostic services and can discuss your path to a smooth and effective recovery.