Achilles Tendon Pain: Causes, Symptoms, and Treatment

The achilles tendon is the largest tendon in the body, connecting the calf to the back of the heel.  The health of this tendon is integral not only in sports, but also in everyday function as its main function is to lift the heel off the ground in order to push off during walking, running, and jumping.  

Because of the significant force the achilles generates, it is very common to develop pain.  Achilles tendon pain comes in the form of:

• Achilles tendinitis
• Achilles rupture
• Insertional achilles pain/heel spur

In all these conditions where, due to an injured Achilles tendon, you feel pain not only when you walk or run, but often early in the morning (just after waking up).

While this brief rundown may be quite self-explanatory, some may find that it creates more questions than it actually answers. So, in order to avoid this pitfall, here’s what you need to know about the causes, symptoms, and treatment of conditions accompanying injuries of the Achilles tendon.

Causes of Achilles Tendon Pain 

There are several reasons why you are experiencing pain in this region. Keep in mind that not all of these causes are as likely.

Achilles tendonitis 

The most common cause is the so-called Achilles tendonitis. This condition is caused by the inflammation in the Achilles tendon region and it is common with athletes and those leading a more dynamic lifestyle, but also occurs with overuse. It’s not just about tendon fatigue, it’s common for people who push this area of their body to extreme limits. In other words, it’s caused by common starts, stops, turns, and even unnatural landings.  Repetitive activity can also contribute to achilles tendonitis. There are several known causes of Achilles tendonitis and the majority of them are completely preventable. For instance, an Achilles tendon pain can happen if you:

• Fail to stretch before training
• Train in cold weather
• Wear improper footwear
• Have a poor running form
• Constant high impact activity without rest

At the same time, different foot deformities (flat feet and high arches) may cause this type of pain, as well.  

Achilles tendinosis 

If not treated long enough, tendonitis can develop into Achilles tendinosis. In this situation, collagen fibers that make your tendon simply break down. The formation of scar tissue that takes place here will sometimes lead to permanent thickening.  The most common sign is a palpable and painful lump in the achilles itself.  In this condition, pain is more constant with weakness.  Often an MRI is performed to evaluate the integrity of the achilles and may also require more aggressive intervention

Insertional Achilles Tendinosis/Heel spur

If the achilles degeneration occurs in the back of the heel, it often can cause painful heel spurs.  These spurs can grow rather large and may become a source of pain when wearing shoes.  At the level of the insertion, calcification in the achilles can occur resulting in the bone spurs from repetitive impact activity, especially if left untreated. Usually, this is visible on regular XRs performed.  

Achilles tendon rupture 

Achilles rupture can be a devastating injury that can occur from high-level athletes to weekend warriors.  The peak age of rupture is roughly between 20-45 years of age. 

Unlike with some of the above-discussed conditions, this injury is instantaneous. In fact, the damage is commonly caused by a misstep or some other sudden overstretch of a tendon (that led to a rupture).  Common scenarios are the first step when playing basketball, chasing a drop shot in tennis, and even certain explosive plyometric exercises.  The most common description is the sensation of something striking the achilles and often can be audible with a “popping” or “snapping” sensation. A gap in the achilles is routinely found.

Achilles ruptures need to be addressed urgently and almost always surgery is recommended.

Risk factors 

Now, before you start self-diagnosing or applying a technique like the Achilles tendon pinch test, it might be worth your while to check out if any risk factors are present.

• Age 30-45 years 
• Men are more likely to develop these issues.
• Steroid injections
• Specific Antibiotics: Flouroquinilones like Cipro and levaquin
• Obesity

Any and all of these can make this problem more likely.

Symptoms Accompanying Achilles Tendon Pain 

While pain is the most obvious symptom of all the conditions we’ve described so far, the key thing you need to bear in mind is that it is usually accompanied by other symptoms.

For instance, mild swelling and warmth usually accompany this pain.

In the morning, you might experience stiffness in both the calf and the heel. However, this gets better later in the day. Warming up (especially stretching) after you get up, is bound to help with this problem. Remember, while sudden Achilles tendon pain may sound more terrifying, it’s this consistency that really gets under one’s skin.

Now, we’ve mentioned pain several times over, however, it’s important to understand that this type of pain has a certain uniqueness to it. The most accurate way to describe this pain (especially with Achilles tendonitis) is to say that it’s a burning sensation that gets more intense over the course of time.

The most common source of this pain comes from the bottom of the calf muscle (which is of a little surprise seeing as how this is where the tendon is located). Sometimes, however, this sensation can even be felt near the heel bone.

Now, even with an in-depth knowledge of the subject matter, unless you’re a trained professional, it’s always better to see a foot and ankle specialist. For instance, if you’re not experienced in this field, Achilles tendonitis can be confused with plantar fasciitis. Self-diagnosing can be difficult, therefore visiting a specialist is always the best course of action.

How are Injuries of the Achilles Tendon Treated? 

An Achilles tendon treatment can come in many different forms.

First, there’s the non-invasive treatment. Here, you’re expected to rest the tendon as much as possible. Now, seeing as how your tendon is quite active every time you walk, it’s recommended to use the crutches until fully healed. Next, there’s applying ice to the injured area. Lastly, you need to keep the ankle from moving for a couple of weeks. One of the ways to achieve this is to use a walking boot.

If the pain becomes unbearable, you can always try to get some over-the-counter anti-inflammatory medication. Just remember that this is merely a temporary pain relief, not a proper treatment.

There are also minimally invasive non-surgical procedures such as the TENEX procedure which can remove scar tissue from a degenerative achilles. This can be done with an ultrasound-guided needle technique.

If surgery is needed, technology has changed the way achilles ruptures are performed.  Minimally invasive achilles repair can now be performed resulting in lower complications and faster recovery times.  

No matter which condition presents itself, physical therapy is also a mainstay in treatment.  It is important in not only gaining strength and motion but also in prevention.

Wrap Up

In the end, regardless of where an Achilles tendon pain comes from, it is always for the best to look for a professional opinion. Sure, the easiest thing to do would be to go online and look up a step-by-step tutorial on a pinch test but things are never as simple. It’s your health that’s at stake so you can’t afford to take any chances.

So, instead of trying to self-diagnose, find a foot and ankle specialist at The Orthopedic Institute of New Jersey.