Achilles Tendonitis Symptoms, Causes & Treatment Options

This article will review the symptoms, causes, management, and prevention of Achilles tendonitis. Symptoms of Achilles tendonitis include creaking or cracking sounds of the ankle, swelling of or hard knots in the area of the tendon, and pain and tenderness in the morning, among others.

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  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. Real-life Stories
  6. When to Seek Further Consultation
  7. Questions Your Doctor May Ask
  8. Read this next
  9. References

What Is Achilles Tendonitis?


The Achilles tendon connects the back of the heel to the muscles of the calves. Achilles tendonitis can be an acute or chronic condition. The term “tendonitis” implies inflammatory cells in the region of the tendon. While this may be true in acute cases of tendon overuse or tendon tear, chronic Achilles tendon pain does not usually have inflammatory cells when looked at under the microscope and is therefore referred to as “tendinopathy.” This condition is most commonly seen in athletes who produce pain through overuse of the tendon, though the condition can present in individuals with a sedentary lifestyle as well. If an Achilles tendon that is producing pain from overuse is not allowed time to rest, the chronic condition can result. This chronic condition generally results in thickening of the tendon and can continue to produce symptoms for months to years.

Recommended care

You should go to a retail clinic to be treated. Common treatments for this condition are rest, alternating applying heat and ice to the tendon, and wearing heel pads to raise the heel and shorten the calf muscles to reduce strain on the tendon.

Achilles Tendonitis Symptoms

As discussed above, the condition “tendonitis” is a general term used to describe the presence of inflammatory cells around a tendon. This may be present in acute forms of the condition, though these cells are generally not seen in chronic forms. As such, this condition may also be referred to as Achilles tendinosis or Achilles tendinopathy.

Main symptoms

Achilles tendonitis may produce the following symptoms [1]:

  • A creaking or crackling sound when moving the ankle or pressing on the Achilles tendon
  • Swelling or hard knots of tissue in the Achilles tendon
  • Stiffness and tenderness in the heel: Especially in the morning, that gradually goes away
  • Pain with certain activities: Pain will likely get worse when walking uphill, climbing stairs, or taking part in intense or prolonged exercise
  • Mild pain or an ache above the heel and in the lower leg: Especially after running or doing other physical activities

Most of these symptoms will be seen in athletes who have recently increased their training regimens.

Achilles Tendonitis Causes

Achilles tendonitis is most commonly seen in athletes, occurring before the age of 45 in many cases [2,3]. Increasing age predisposes an individual to tendonitis because as the tendons age, the collagen within them becomes less durable, predisposing them to injury more easily [4]. Achilles tendonitis is considered chronic if symptoms last greater than three months. This condition often becomes chronic as there are areas of the Achilles tendon with a lower blood supply, which reduces the rate at which injuries to the tendon are able to be healed.

The cause of the condition is repeated, intense strain on the Achilles tendon. The condition is more likely to occur when someone suddenly increases the amount of time spent on their feet or increases the intensity of their training regimen. Other risk factors include [1]:

  • Initiating sports that require sudden starts and stops: Such as basketball or tennis
  • Shoe choices: A change in shoes or repeatedly wearing worn out, unsupportive shoes
  • Running up hills: This can increase the stretch on the Achilles tendon and cause injury.
  • Other leg and foot characteristics: Such as weak calf muscles, flat arches of the feet, feet that roll inwards when running (overpronation), or feet that roll outwards when running (oversupination)
  • Intense exercise regimens without stretching or warming up

Achilles Tendonitis Symptom Checker

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Treatment Options and Prevention for Achilles Tendonitis


The treatment of Achilles tendonitis is usually conservative therapy with regimented physical therapy, activity adaptation, and pain management. Tendons that are injured due to overexertion or overuse undergo biological changes and, as a result, are less able to absorb the force exerted on them with movement. To allow these biological changes to reverse, the exertion or strain on the tendon should be modified, and thus practice time may need to be reduced.

The management of acute Achilles tendonitis is as follows:

  • Avoidance of painful activities
  • Application of ice when experiencing pain
  • Seven to 10 days of non-steroidal anti-inflammatory medications
  • Taping the heel so that it is lifted: Thus reducing extension of the tendon

The management of chronic Achilles tendonitis (>3 months) is as follows [5]:

  • All the measures listed above for acute tendonitis
  • Rehabilitation exercises with heavy loads: The idea of this measure is to gradually strengthen the tendon and promote healing. A common exercise prescribed for Achilles tendonitis is weighted heel raises.


Data suggests that the lifetime incidence of Achilles tendonitis is as high as 24 percent in competitive athletes [3]. There are certain risk factors for Achilles tendonitis that cannot be altered by individuals (e.g. male gender and increasing age). However, other risk factors can be mitigated in an effort to prevent tendonitis. Wearing proper footwear with adequate support, maintaining strong leg muscles, gradual increases in exercise regimens, and stretching are all generally recommended by doctors as preventative measures [1].

There is also a rare association between taking fluoroquinolones, a type of antibiotic, and the development of Achilles tendinopathy and tendon rupture. If this rare complication develops, it usually occurs within a week of starting the drug [6].

Real-life Stories

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When to Seek Further Consultation for Achilles Tendonitis

Both athletes and non-athletes who begin experiencing pain in the Achilles tendon should consult their doctor. While this is not a medical emergency, earlier management and intervention can prevent the condition from becoming chronic. Early intervention with rest, ice, pain management, and bandaging can help prevent the tendon from thickening and developing scar tissue.

Questions Your Doctor May Ask to Determine Achilles Tendonitis

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • How severe is your foot pain?
  • How long has your foot pain been going on?
  • Is your foot pain getting better or worse?
  • Is your foot pain constant or come-and-go?
  • Did you just suffer from a cut or wound?

If you've answered yes to one or more of these questions

Achilles Tendonitis Symptom Checker

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  1. Shah SA. Achilles tendonitis. Nemours: TeensHealth. Updated December 2014. KidsHealth Link
  2. Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22(4):675-692. PubMed Link
  3. Kujala UM, Sarna S, Kaprio J. Cumulative incidence of achilles tendon rupture and tendinopathy in male former elite athletes. Clin J Sport Med. 2005;15(3):133-5. PubMed Link
  4. O'Brien M. Structure and metabolism of tendons. Scand J Med Sci Sports. 1997;7(2):55-61. PubMed Link
  5. Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000;29(2):135-46. PubMed Link
  6. van der Linden PD, van Puijenbroek EP, Feenstra J, et al. Tendon disorders attributed to fluoroquinolones: A study on 42 spontaneous reports in the period 1988 to 1998. Arthritis Rheum. 2001;45(3):235-9. PubMed Link

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