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If your Achilles hurts, the pain is most likely due to overuse of the tendon. Learn about what causes Achilles pain and how to treat it
Your Achilles is the largest tendon in your body, connecting your calf muscles to your heel bone. You use it when you walk, run, climb stairs, jump, or stand on your toes.
If your Achilles hurts, the pain is most likely due to overuse of the tendon. Achilles pain is common among athletes and long-distance runners, especially if they haven’t stretched properly or aren’t wearing the proper footwear.
Achilles pain may also be caused by Achilles tendonitis, a condition in which the tendon becomes inflamed and painful.
What are risk factors for Achilles tendonitis?
Your Achilles tendon tends to weaken with age. Factors that increase your risk for developing Achilles tendonitis include
- Naturally flat arch in the foot
- Tight calf muscles
- Obesity
- Psoriasis
- Hypertension (high blood pressure)
- Fluoroquinolone antibiotics (e.g., ciprofloxacin)
- Running in worn-out shoes
- Running on hilly terrain
If you continue to work out or perform physical activities that put more strain on your Achilles, you risk injuring the tendon further, which can lead to a partial tear (rupture) or a full tear.
What are symptoms of Achilles tendonitis?
If you have developed Achilles tendonitis, you may experience symptoms such as:
- Mild ache in the back of the leg or above the heel after running
- More severe pain after prolonged running or stair climbing
- Limited range of motion when you try to flex your foot
- Tenderness or stiffness in the back of your heel, especially in the morning, which usually improves after you get up and walk around
How is Achilles pain assessed?
If your Achilles is sore, your doctor will check for tenderness, flexibility, and alignment of the structures in the ankle and foot. They may also order certain imaging tests to check for any changes in the tendon:
- X-rays: X-ray tests provide clear images of the bones and calcification or hardening of the tendons.
- Magnetic resonance imaging (MRI): MRI scans can confirm Achilles tendonitis and are typically used to assess the extent of damage to the tendon and determine what type of surgery may be needed.
How to prevent Achilles tendon injuries
While it may not always be possible to prevent Achilles injuries, you can reduce your risk:
- Warm up before training or working out.
- Stretch regularly, especially your calf muscles and Achilles tendon.
- Avoid increasing your activity levels too quickly.
- Strengthen your calf muscles.
- If you are over age 60, avoid activities that put excessive strain on your tendons such as hill running.
- If you have a flat arch, choose shoes with ample support and cushioning (consult your podiatrist regarding custom-made shoes)
- Buy a new pair of shoes if your shoes have worn out.
How is Achilles pain treated?
Treatment for Achilles tendon pain ranges from home remedies to surgical intervention.
RICE (rest, ice, compression, elevation)
- Rest. Avoid exercises that put strain on your Achilles tendon. You may need to use walking boots or crutches to minimize the strain on your tendon.
- Ice. Apply an ice pack over a sore Achilles tendon for 15 minutes at a time to reduce pain and inflammation.
- Compression. Wear compression wraps or bandages over the tendon to limit movements and reduce swelling.
- Elevation. When resting, elevate the affected foot above heart level to reduce swelling.
Over-the-counter painkillers
You can take over-the-counter (OTC) pain medications such as ibuprofen or naproxen to alleviate pain.
Medications
If OTC medications do not help reduce inflammation and pain, your doctor may prescribe stronger medications such as:
- Steroid injections locally into the tendon (this can further weaken the tendon, however)
- Platelet-rich plasma injections
Physical therapy
Physical therapy is an important part of treatment and helps with faster recovery:
- Stretching and strengthening exercises
- Orthotic devices (shoe inserts or wedges with cushioning)
Surgery
If the above treatments fail to improve Achilles tendonitis symptoms, surgery to repair the Achilles tendon may be the last resort to resolve the issue permanently.
