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Key Takeaways
- Achilles tendinitis is an overuse injury that causes pain, swelling and stiffness in the Achilles tendon, which connects your calf muscles to your heel bone.
- It often develops gradually due to repetitive activities such as running, jumping or suddenly increasing your exercise intensity.
- Most people recover with non-surgical treatment, including activity modification, physiotherapy and exercises, but early treatment helps prevent long-term tendon damage.
Do you feel pain or stiffness at the back of your heel when you take your first steps in the morning or after a run? While it may seem like a minor ache at first, it could be Achilles tendinitis – an overuse injury that can make walking, exercising, and even climbing stairs uncomfortable.
What is Achilles tendinitis?
Achilles tendinitis is inflammation or irritation of the Achilles tendon, the strong band of tissue that connects your calf muscles to your heel bone (calcaneus).
Every time you walk, climb stairs, run or jump, your Achilles tendon helps lift your heel off the ground and push your foot forward. Because it is one of the strongest and most heavily used tendons in your body, it is also prone to overuse injuries.
Achilles tendinitis usually develops gradually rather than after a single injury. You may first notice mild pain after exercise that improves with rest. Without treatment, the pain can become more frequent and begin to affect everyday activities such as walking or climbing stairs.
Although the terms Achilles tendinitis and Achilles tendinopathy are often used interchangeably, tendinopathy is the broader term that includes both inflammation (tendinitis) and long-term tendon degeneration (tendinosis).
Achilles tendinitis is the gradual irritation or inflammation of the Achilles tendon.
What causes Achilles tendinitis?
Achilles tendinitis usually develops when repeated stress is placed on your tendon faster than it can repair itself.
Common causes include:
- Suddenly increasing your running distance or training intensity
- Starting a new exercise programme without gradually building up
- Running uphill frequently
- Sprinting or jumping repeatedly
- Tight calf muscles that increase tension on the tendon
- Poor running technique
- Wearing shoes that do not provide enough support
- Exercising on hard or uneven surfaces
- Returning to sports too quickly after an injury
In some cases, Achilles tendinitis develops without a clear injury and is simply the result of accumulated wear and tear over time.
Common risk factors for Achilles tendinitis
You may be more likely to develop Achilles tendinitis if you:
- Are between 30 and 60 years old
- Run regularly, especially long distances
- Play sports involving running and jumping, such as football, basketball or tennis
- Suddenly increase your physical activity
- Have tight calf muscles
- Have flat feet or very high arches
- Are overweight or obese
- Wear worn-out or poorly fitting footwear
- Have had a previous Achilles tendon injury
- Have certain medical conditions, such as diabetes, rheumatoid arthritis or high cholesterol
- Smoke
- Take certain medications, including fluoroquinolone antibiotics or long-term corticosteroids
Having one or more risk factors does not mean you will definitely develop Achilles tendinitis, but it does increase your risk.
Types of Achilles tendinitis
Doctors classify Achilles tendinitis based on the part of the tendon that is affected.
Non-insertional Achilles tendinitis
- Affects the middle portion of the Achilles tendon.
- More common in younger, active people and runners.
- May cause pain, swelling, and thickening of the tendon.
Insertional Achilles tendinitis
- Affects the point where the Achilles tendon attaches to the heel bone.
- Can occur in people of any age or activity level.
- Bone spurs may develop in some cases, causing additional irritation.
Note: Long-standing Achilles tendinitis can lead to thickening or hardening (calcification) of the tendon in either type.
Achilles tendinitis symptoms
If you have Achilles tendinitis, you may notice:
- Pain at the back of your heel or along your Achilles tendon, especially during or after activity
- Stiffness in your tendon, particularly when you take your first steps in the morning
- Tenderness when you touch the tendon
- Swelling or thickening along the back of your heel or Achilles tendon
- Weakness in your calf or ankle, which may make it difficult to push off the ground, climb stairs, or stand on your tiptoes
- Reduced flexibility or difficulty moving your ankle comfortably
- Symptoms that improve with rest but return when you become active again
Most people notice that the pain develops gradually and becomes worse if they continue activities that put stress on the tendon.
When should you see a doctor?
You should see a doctor if:
- Your Achilles pain lasts longer than a few days despite rest
- The pain keeps returning whenever you exercise
- You have difficulty walking
- Your tendon becomes increasingly swollen or thickened
- You cannot stand on your tiptoes
- You feel weakness in your ankle
- You hear or feel a sudden "pop" in the back of your ankle, followed by severe pain or difficulty walking, as this may indicate an Achilles tendon rupture
Early treatment may help prevent more serious tendon damage.
Speak with our care team today to be matched with an orthopaedic specialist who can assess your condition, explain your options, and help you plan the next steps in your treatment.
Possible complications of Achilles tendinitis
If Achilles tendinitis is left untreated or you continue activities that strain the tendon, it can lead to complications. The tendon may gradually weaken over time (Achilles tendinosis), causing persistent pain and stiffness. In more severe cases, the tendon may partially or completely tear (Achilles tendon rupture), which often causes a sudden "pop", severe pain and difficulty walking, and may require surgery.
How is Achilles tendinitis diagnosed?
Therapist palpating the Achilles tendon during a clinical assessment.
Your doctor can often diagnose Achilles tendinitis based on your symptoms and a physical examination.
During your appointment, your doctor may:
- Ask when your symptoms started
- Discuss your sports and activity level
- Examine your Achilles tendon for swelling and tenderness
- Check your ankle movement
- Assess your calf strength
- Watch you walk or stand on your toes
If another condition is suspected or surgery is being considered, imaging tests may be recommended.
These include the following:
- Ultrasound can show tendon thickening, inflammation and small tears.
- MRI provides detailed images of the tendon and helps identify tendon degeneration, partial tears or a complete rupture.
- An X-ray does not show the tendon itself but may identify bone spurs or other conditions affecting the heel.
Achilles tendinitis treatment
Treatment depends on how severe your symptoms are and how long they have been present.
Most people improve without surgery.
Non-surgical treatments
Your doctor may recommend one or more of the following.
Activity modification
Temporarily reduce or avoid activities that trigger your symptoms, particularly running and jumping.
Low-impact exercises such as swimming or cycling may be recommended while your tendon heals.
Rest
Giving your tendon time to recover is an important part of treatment.
Complete bed rest is usually unnecessary, but reducing activities that worsen your pain allows the tendon to heal.
Ice therapy
Applying an ice pack wrapped in a towel for 15 to 20 minutes several times a day may help reduce pain and swelling, especially after activity.
Pain relief medications
Your doctor may recommend pain-relieving or anti-inflammatory medications for short-term symptom relief if appropriate.
Physiotherapy
Physiotherapy is one of the most effective treatments for Achilles tendinitis.
A physiotherapist may guide you through:
- Eccentric calf strengthening exercises
- Calf stretching exercises (when appropriate)
- Balance training
- Gradual return-to-sport programmes
Exercise therapy helps improve tendon strength and reduces the risk of recurrence.
Heel lifts or orthotics
Heel lifts may temporarily reduce strain on the Achilles tendon.
If you have flat feet or abnormal foot mechanics, custom orthotics may also help.
Extracorporeal shockwave therapy (ESWT)
ESWT uses sound waves to stimulate healing in the tendon and may be recommended if symptoms persist despite several months of conservative treatment.
Surgical treatments
Surgery is usually considered only when:
- Symptoms persist after 3 to 6 months of non-surgical treatment
- There is severe tendon degeneration
- Large bone spurs continue to irritate the tendon
- There is a partial or complete tendon tear
Depending on your condition, surgery may involve:
- Removing damaged tendon tissue
- Repairing the tendon
- Removing bone spurs
- Reattaching the tendon to the heel bone if necessary
Your surgeon will discuss the most suitable option based on your symptoms and imaging results.
What should you avoid if you have Achilles tendinitis?
While your tendon is healing, try to avoid:
- Running through pain
- Sprinting or jumping
- Suddenly increasing your exercise intensity
- Wearing worn-out or unsupportive shoes
- Walking barefoot for long periods on hard surfaces
- Ignoring persistent symptoms
- Returning to sports before your doctor or physiotherapist says it is safe
Continuing high-impact activities despite ongoing pain may increase your risk of tendon rupture.
How to prevent Achilles tendinitis?
Although not every case can be prevented, you can reduce your risk by:
- Increasing your training gradually
- Warming up before exercise
- Stretching and strengthening your calf muscles regularly
- Wearing supportive footwear suitable for your activity
- Replacing running shoes when they become worn
- Varying your exercise routine with low-impact activities
- Allowing adequate recovery between workouts
- Treating minor Achilles pain early before it becomes more severe
How HiA helps
If you're experiencing persistent pain at the back of your heel or think you may have Achilles tendinitis, Health in Asia (HiA) can help you connect with experienced orthopaedic specialists, sports medicine doctors and physiotherapists in Singapore.
Whether you need an assessment, imaging such as an ultrasound or MRI, a second opinion, or guidance on treatment options, HiA makes it easier to find and book appointments with the right healthcare provider.
Not sure whether your Achilles pain needs medical attention? Talk to our Care Team on WhatsApp —we'll help you understand your options and connect you with an appropriate specialist.
Frequently asked questions
Mild cases may improve with rest and activity modification, but many people continue to have symptoms if the underlying cause is not addressed. Seeking treatment early can help prevent the condition from becoming chronic.
Yes. If Achilles tendinitis is left untreated, ongoing stress can weaken the tendon over time. This increases the risk of a partial tear or a complete Achilles tendon rupture, particularly during activities such as sprinting or jumping.
Shoes that provide good cushioning, arch support and a slightly raised heel may help reduce strain on the Achilles tendon. Avoid worn-out shoes or footwear with little support, such as thin flip-flops, especially if they worsen your symptoms.
Yes. Achilles tendinitis can recur, particularly if you return to high-impact activities too quickly, skip strengthening exercises or continue training with poor footwear or biomechanics. Following your rehabilitation programme and increasing activity gradually can help reduce the risk of recurrence.
Yes. Send us the report. We'll help you make sense of it, so you walk into the appointment with the right questions.
Yes. Send us what you have. If anything's missing, we'll tell you exactly what to request and how.
Disclaimer
This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition. For decisions about your health or treatment, speak with a qualified doctor who knows your situation. An…
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