Achilles Tendonitis

The Achilles tendon is the large, rope-like band at the back of the ankle where the calf muscles attach to the heel bone. Achilles tendinopathy is a gradual breakdown of the tendon's collagen when repeated overloading outpaces its ability to repair itself. The tendon thickens, its structure becomes disorganized, and it becomes painful and stiff. The mid-portion type sits a few centimeters above the heel; the insertional type sits at the heel attachment and responds less reliably to the usual exercises. The condition cannot be fully reversed, but the tendon can be retrained to tolerate load, and most people improve and return to the activities they value.

Common symptoms include:

• Stiffness and pain with the first steps of the morning that ease as you warm up
• Pain that returns later in the day after prolonged activity
• A tendon that feels thickened and tender when squeezed at the sore spot
• A small lump along the tendon in the mid-portion type
• Symptoms worst the morning after heavy activity rather than during it

The diagnosis is usually made from the history and examination. The morning-stiffness pattern, a thickened and focally tender tendon, and activity-related pain are typically enough. Ultrasound in the clinic can confirm it and guide injections, while MRI is reserved for unclear cases or when surgery is being considered.

The large majority of people improve without surgery:

• A heel-lowering exercise that loads the tendon to drive remodeling, the core of treatment
• Load management, reducing activity then rebuilding it gradually
• A small heel lift, especially helpful for the insertional type
• Physical therapy for progressive loading and technique guidance

Cortisone is not injected into the Achilles tendon, because it raises the risk of rupture. Surgery is considered after a sustained trial of loading and other measures has not helped, and it removes degenerated tendon tissue through a minimally invasive approach.

For a fuller explanation, including anatomy, diagnosis, and the full range of treatment:

• Achilles Tendinitis — AAOS OrthoInfo