Achilles Tendonitis

Achilles tendonitis is a condition that affects the tendon connecting the calf muscles to the heel bone. It develops when the tendon is subjected to repetitive stress or a sudden increase in activity, leading to inflammation, stiffness, and discomfort. This condition can make walking, running, and climbing stairs difficult. Without proper management, symptoms may persist and interfere with daily activities.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS | MRCS (UK) | MMed (Surgery) | FRCS (UK)

Symptoms Causes Diagnosis Treatment Prevention FAQ

Symptoms of Achilles Tendonitis

The severity and duration of Achilles tendonitis influence the symptoms experienced. Common symptoms include:

Morning Stiffness and Pain

Discomfort along the Achilles tendon is often more noticeable during the first few steps after waking up. Symptoms usually improve with movement.

Pain During Activity

Pain develops or worsens with exercise, particularly activities that involve running, jumping, or climbing stairs. Longer or more intense sessions tend to increase discomfort.

Tenderness to Touch

When pressed, the affected area is sensitive, typically 2–3 centimetres above the heel bone.

Swelling

Swelling may develop along the tendon or near its attachment to the heel, sometimes accompanied by warmth.

Causes and Risk Factors

Several factors contribute to Achilles tendonitis, including activity levels, structural issues, and underlying health conditions.

Increased Activity Without Conditioning

Rapidly increasing exercise intensity or duration without proper conditioning strains the tendon. This occurs when starting a new training programme or resuming exercise after a break.
Reduced Tendon Flexibility

The Achilles tendon becomes less flexible with age, increasing the likelihood of irritation and injury.
Repetitive Stress from Sport or Exercise

Running, jumping, and sudden directional changes place strain on the tendon, making it more prone to inflammation.
Foot Structure and Alignment Issues

Flat feet, high arches, or improper footwear can increase stress on the tendon.
Underlying Medical Conditions

Rheumatoid arthritis, diabetes, and other systemic conditions can affect tendon health and slow recovery.

Diagnostic Methods

Physical Examination: Swelling, tenderness, and range of motion are assessed through specific movement tests. These evaluations provide insight into tendon flexibility, strength, and severity of the condition.
Medical Imaging: Ultrasound or MRI scans provide detailed images of tendon structure, showing inflammation, degeneration, calcium deposits, or bone spurs. These scans help determine the condition’s type and extent.
Thompson Test: This test assesses tendon function. The calf muscle is squeezed while lying face down with the feet hanging off the edge of a table. A typical response causes the foot to move; if there is no movement, it may indicate a tendon rupture.

Treatment Options

Treatment varies depending on the severity and duration of symptoms. Many cases improve with non-surgical measures, but persistent cases may require surgical intervention.

Non-Surgical Treatment

Activity Modification: Reducing activities that worsen symptoms allows the tendon to heal. Low-impact exercises, such as swimming or cycling, may help maintain fitness during recovery.
Physiotherapy: A structured exercise programme strengthens the calf muscles and improves tendon flexibility. Treatment often begins with gentle stretching and progresses to strengthening exercises.
Pain Management: Applying ice packs to the affected area for 15–20 minutes several times daily may help reduce inflammation and ease discomfort. Non-steroidal anti-inflammatory drugs can provide short-term pain relief but do not accelerate healing. Topical anti-inflammatory gels and other methods may also help manage symptoms.

Surgical Treatment

Debridement and Repair: This procedure involves removing damaged tendon tissue, thickened areas, and any bone spurs that have formed at the tendon’s attachment point. By eliminating deteriorated sections, the remaining healthy tendon can function more effectively. Sometimes, the tendon is reinforced with sutures to improve its strength and flexibility.
Tendon Transfer: When a significant portion of the Achilles tendon is damaged and cannot be repaired effectively, a nearby tendon, most commonly the flexor hallucis longus (FHL) tendon from the lower leg, is used to reinforce the affected area. This helps restore function and allows for better movement without compromising essential foot mechanics.

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Prevention and Long-Term Management

Preventing Achilles tendonitis and reducing the risk of recurrence involves maintaining flexibility, managing physical activity, and minimising strain on the tendon. Regular calf stretching helps keep the tendon flexible, while gradually increasing training intensity allows it to adapt without excessive stress.

Wearing well-cushioned footwear or orthotic inserts can help distribute pressure more evenly, reducing unnecessary strain. A varied exercise routine, incorporating activities like swimming or cycling, prevents overuse of the same muscle groups. Managing body weight also lessens the load on the lower limbs, supporting overall tendon health.

Frequently Asked Questions (FAQ)

How long does recovery take?

Recovery varies based on the severity of the condition and adherence to treatment. Most cases improve within six weeks to six months, with many people returning to normal activities in about three months.

Can Achilles tendonitis become chronic?

If left untreated or if the tendon is repeatedly strained, symptoms may persist or worsen over time, potentially leading to long-term tendon degeneration.

Should I stop all exercise during recovery?

Not necessarily. Low-impact activities that do not cause pain, such as swimming or cycling, may still be suitable depending on symptom severity and individual response.

Dr. Chok Aik Yong

Colorectal Surgeon & General Surgeon

MBBS|MRCS (UK)|MMed (Surgery)|FRCS (UK)

Expertise lies in managing colorectal diseases, particularly advanced colorectal cancer and inflammatory bowel disease.

Dr Chok graduated with degrees in Bachelor of Medicine and Surgery from the National University of Singapore. He was conferred the Master of Medicine (Surgery) in Edinburgh (UK) and a member of the Royal College of Surgeons, UK. He subsequently completed his specialist training in colorectal surgery and became a Fellow of the royal college of Surgeons in Edinburgh in 2016.
Dr Chok was awarded the Health Manpower Development Plan (HMDP) award in 2019 to further advance his colorectal training at Royal Marsden Hospital, one of the top 5 cancer centres in the world. While in London, Dr Chok trained with pioneers in the surgical management of advanced colorectal cancer and inflammatory bowel disease (IBD) and gained extensive experience while appraising the latest clinical and research evidence.

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