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Achilles Tendonitis

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What Is Achilles Tendonitis?

Achilles tendonitis is a painful condition that occurs when the Achilles tendon (the tendon at the back of the ankle that connects your heel to your calf) becomes inflamed.  It is characterized by pain and swelling above the back of the heel when running or walking.  As it progresses, it can make climbing stairs, or any movement involving the foot and ankle, very difficult.

If left untreated, the inflammation can worsen and become chronic.  However, with proper attention by a foot specialist, it can be treated, managed and prevented from reoccurring. 


What Are The Symptoms Of Achilles Tendonitis?

Common signs and symptoms of Achilles tendonitis are:

  • Pain above the back of the heel or ankle when walking, running or climbing stairs.  It can feel like a mild ache or a sharp pain.  
  • Swelling at the the back of the ankle (by the tendon)
  • Irritation and tenderness when pressure is applied to the area
  • Difficulty moving the foot and ankle
  • Limited motion when flexing the foot
  • Tightness in the calf muscles (the muscles at the back of the lower part of your leg, between the ankle and the knee).

Signs of inflammation and damage caused by Achilles tendonitis may appear in an MRI or ultrasound.

The symptoms of Achilles tendonitis are non-specific and can often be mistaken for other conditions.  If you have persistent heel or ankle pain, schedule an assessment with one of our foot specialists to identify the cause.


What is the Achilles Tendon?

The Achilles tendon is the largest, strongest and one of the most important tendons in your body:  Any movement of the toes, ankle, heel and calf involves the Achilles tendon.  It also absorbs a lot of force every time you bear weight on your toes and feet (i.e.: walking, running, jumping, standing on your toes).  Despite the Achilles tendon’s heavy workload, it receives relatively poor blood supply.  This makes it very vulnerable to injury.

What Causes Achilles Tendonitis?

Achilles tendonitis develops when this tendon is overworked due to persistent strain.  This can be caused or contributed to by:

  • Deconditioning:  When the muscles in the lower body weaken and become deconditioned due to lack of physical activity, the Achilles tendon has to work extra hard to pick up the slack.  It gets overworked and inflamed as a result (like the biological equivalent of workplace burnout).  Deconditioning also tightens our leg muscles, which further increases the strain on the Achilles tendon. 
  • Obesity:  Similar to deconditioning, obesity increases the weight and burden on the Achilles tendon, which makes it more injury-prone.
  • Rheumatoid Arthritis, Psoriatic Arthritis and other joint disorders.
  • Achilles Bursitis (also known as paratenon or retrocalcaneal bursitis):  This is inflammation of the fluid sac (the bursa) that lies between the Achilles tendon and the heel.  It causes pain in the back of the heel and, due to its proximity to the Achilles tendon, can lead to Achilles tendonitis if left untreated.  
  • High impact physical activity (i.e.: running, ballet, activities that involve excessive flexing of the foot combined with high impact)
  • Trauma
  • Biomechanical abnormalities that lead to repetitive strain and stress of the Achilles tendon

Without proper treatment, Achilles tendonitis can turn into a more chronic condition called Achilles tendonosis.  Achilles tendinosis is characterized by non-inflammatory degeneration of the tendon. It is usually caused by repetitive trauma and inadequate healing. In worst case scenarios, the Achilles tendon may rupture or tear.  

Often, nearby structures can be the cause of the problem, so it is important to have a foot specialist treat the condition appropriately.

For another common cause of heel pain, see plantar fasciitis.

If you have persistent heel or ankle pain, schedule a diagnostic assessment at our Toronto foot clinic to identify the cause of pain. To schedule an assessment use our online booking form or call 416-769-FEET(3338). You do not need a referral to become a patient at our clinic.


How Do I Treat Achilles Tendonitis?

Because of the important role the Achilles tendon plays in our movement, it is important to treat Achilles tendonitis as early as possible to prevent complications.  

Achilles tendonitis treatment may include:

  • Strengthening and stretching exercises:  Many of these exercises are quick, easy and accessible.  They can be done at home while sitting on your couch.  Just a few minutes of light strengthening exercises while watching television can go a long way toward recovery and prevention.  View our Pinterest page for video demonstrations and infographics that will help you treat and prevent Achilles tendonitis.  
  • Rest or decrease in activities:  You specifically would want to limit movement and activities that involve putting weight on your toes, like prolonged walking, running or jumping
  • Shockwave Therapy: This non-invasive innovative treatment delivers high energy sound wave pulses to the affected area. It triggers your body’s natural healing response so it can repair the Achilles tendon and reduce pain. Shockwave therapy is used to treat chronic Achilles tendonitis persisting longer than 6 months, as well as Achilles tendinosis and any other chronic related soft tissue injuries in the foot and ankle. Note: At Feet First Clinic we cannot apply shockwave therapy treatment above the ankle.
  • Custom orthotics that slightly elevate your heel:  These will alleviate the repetitive strain placed on the Achilles tendon when you move.  
  • Over-the-counter insoles that increase cushioning under your heel:  These support the tendon and absorb some of the force placed on it during movement.  By alleviating that force, the tendon has the opportunity to heal while you do your activities.  
  • Anti-inflammatories:  These include drugs like Ibuprofen or Naproxen, which decrease inflammation and alleviate pain while the tendon heals. 

Early proactive treatment of Achilles tendonitis will go a long way toward full recovery.  If you have persistent heel or ankle pain, schedule an assessment with one of our foot specialists to identify the cause of the pain and find a treatment plan that works best for you. (Click here for more information about what happens during a Foot Assessment at Feet First Clinic).

You do not need a referral to become a patient at our Foot clinic.

We also offer a large selection of supportive footwear, Superfeet insoles, and compression sleeves for Achilles tendonitis (see our Products).

Contact us for more for information about how we can help treat your Achilles tendonitis.

Risk Factors

Risk Factors

Achilles tendonitis is often a repetitive strain injury. Although anyone can get it, the following risk factors increase strain on the tendon, therefore making you more vulnerable to developing Achilles tendonitis: 

  • Running in worn-out sneakers
  • Wearing shoes with elevated heels for long periods of time
  • Inactive lifestyle / lack of physical exercise:  This leads to deconditioning (weakening of the joints and muscles), which increases the burden on the Achilles tendon. 
  • Obesity:  Similar (and often related) to deconditioning, obesity increases the weight and burden on the Achilles tendon, which makes it more injury-prone.
  • Rheumatoid Arthritis and other joint disorders:  People with a type of Rheumatoid Arthritis called Ankylosing Spondylitis (which affects the joints in the spine) have been found to be more at risk for developing Achilles tendonitis. 
  • Biomechanical abnormalities in the feet and lower body that lead to repetitive strain and stress of the Achilles tendon
  • Flat feet
  • High arches
  • Sudden increase in intensity of activity 
  • High impact sports, such as:
    • Running
    • Sports that involve jumping or hopping such as tennis and basketball
    • Sports that involve quick stop-and-go motions such as football and soccer 
  • Tight calf muscles:  The Achilles tendon connects the calf to the heel.  When the calf is tight, it pulls on the Achilles tendon. 


How Do I Prevent Achilles Tendonitis?

There are a number of things you can do to prevent Achilles tendonitis:

  • Stretch, stretch and…stretch!  Stretching improves circulation to our muscles and loosens them.  This is essential for joint health: tight muscles pull on our tendons, which then pull on our joints. When it comes to preventing Achilles tendonitis, regularly stretching your calves and the area behind your ankle is one of the best ways to keep your Achilles tendon happy and healthy. You should stretch:
    1. Daily:  It’s important to stretch the muscles throughout our body regularly in any event.  
    2. Before and after exercise:  So many people unfortunately skip this essential step when they work out, and pay the consequences for it (think cascading injuries, post workout stiffness and aches – these are all things that happen when you don’t stretch).  Stretching your calves and thighs before and after exercise will substantially improve your recovery time and reduce strain in the knees and ankles. 

You can start by trying some of these stretches from VeryWellFit. For more information about stretching, check out our blog article on “The Perfect Stretching Routine”.

  • Strengthen and condition the muscles in your feet, calves and thighs: It may be a nursery rhyme, but there is much truth to the Skeleton Song:  “The foot bone’s connected to the leg bone; The leg bone’s connected to the knee bone; The knee bone’s connected to the thigh bone…” (Bringing back any memories?) The point is, everything in our body is connected, and by strengthening and conditioning the muscles in our feet, calves and thighs, it reduces strain and stress on the Achilles tendon.  Here are some great foot and lower body exercises from our Pinterest page  that are super-effective at preventing Achilles tendonitis.
  • Properly warm up prior to exercise:  This relates to stretching (which is one of the ways we can warm up our body prior to exercise).  Warming up our body before we exercise improves circulation and loosens the muscles.  This allows them to move easier, withstand the exertion of our exercise, and keeps them from getting tight afterwards (i.e.: post-workout stiffness).  A great way to warm up your body prior to exercise is through something called dynamic stretching.  You can check out some tips on dynamic stretching in this Healthline article.  For ankle-specific dynamic stretching, you can read this article from  
  • Gradually increase activity level (duration and intensity) if starting or modifying an exercise regimen:  This prevents the muscles and joints from being overexerted before they are strong enough to endure the increased level of activity. 
  • Combine high-impact sports with low-impact activities such as cycling and swimming
  • Replace worn out running shoes:  The Achilles tendon withstands a lot of force when we run, so a good running shoe helps offset its workload, encourages proper biomechanics and reduces repetitive strain.  You can check out our extensive footwear selection for some great options. 
  • Avoid/reduce wearing high heel shoes:  The Achilles tendon (and just about every other part of our body) hates high heels – they disrupt our gait and biomechanics. Wearing high heels all the time can also gradually shorten the calf muscle, which is one of the major risk factors for Achilles tendonitis.
  • Get custom orthotics to accommodate and address any biomechanical abnormalities: Orthotics can correct any irregularities with our gait, which in turn ensures everything in our body can move the way it was designed to.
  • Wear supportive footwearFootwear with good arch support and shock absorption will alleviate strain and stress on the Achilles tendon.

These activities are not just effective at preventing Achilles tendonitis; they are good for us in general.  Even if you’re not at risk for Achilles tendonitis, these are great things you can do to prevent injury in other areas of your body.

Looking for solutions to help treat and prevent foot pain? Call us at 416-769-FEET (3338) or use the online booking form below to see how we can help! No referral needed!

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Carolina Charles

Patient Relation Coordinator (She/Her)

If you’ve been to the clinic before, chances are you had the pleasure of meeting Carolina! Carolina’s daily goal is going above and beyond to make sure patients are always completely satisfied. Having worked in the podiatry industry for 22 years, Carolina brings a wealth of knowledge pertaining to client service, insurance policies, and procedures.​ She steers the ship to make sure everything runs smoothly on the daily. Carolina is known for spicing up every outfit with her signature costume jewellery.