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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. Stretching and strengthening exercises for Achilles tendonitis also address and prevent other lower body conditions, so it’s good to do them even if you don’t have Achilles tendonitis.  


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.

There are many conditions that can cause symptoms of Achilles tendonitis, which can lead to misdiagnosis.  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 (kind of like 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 and other joint disorders.
  • Achilles Bursitis (also known as paratenon or retrocalcaneal bursitis):  This an 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 resulting in thickening and scar tissue formation. 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 with our practice 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 it as early as possible in order 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 of stretches and exercises 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.
  • 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 from walking.  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 the inflammation and alleviate the symptoms of 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 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, sneakers, and cushioning insoles (see What’s In Store) for Achilles tendonitis.

Our Toronto foot clinic is open six days a week. 

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 Achilles tendon’s burden. 
  • 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 or 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.  To prevent Achilles tendonitis, stretching your calf muscles, as well as the other muscles in your legs (i.e.: the muscles in your thighs) goes a long way.  You should stretch:
    1. Daily:  It’s important to stretch the muscles throughout our body regularly in any event.  Stretching your calves and the area behind your ankle daily will help keep your Achilles tendon happy and healthy. 
    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. 

It may feel like you don’t have time to stretch (it was probably hard enough just to squeeze in time to exercise) but try to view it as an investment: Just a few minutes stretching before and after physical activity can save you the inconvenience of injury, which consumes even more time.  So by stretching, you’re actually saving time in the long run.   

You can start by trying some of these stretches from VeryWellFit.  

  • 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, loosens the muscles and gets them ready for physical activity and exertion.  This allows muscles to move easier, withstand the exertion of our exercise, and keeps them from getting tight afterwards (i.e.: post-workout pain).  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 arthritis.org.  
  • 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. 
  • 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 stretches from our Pinterest page to keep your body moving that are super-effective at preventing Achilles tendonitis.
  • 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 wearing shoes with excessively high heels:  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.
  • Get custom orthotics to accommodate and address any biomechanical abnormalities: Footwear that encourages good biomechanics alleviates strain and stress on the Achilles tendon.  Orthotics can correct any irregularities with our gait, which in turn ensures everything in our body can move the way it was designed to.

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 for your overall health to prevent injury in other areas of your body.  

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