Updated 15 August 2022 | Approved By Dr. Umberto Russo
What is Achilles Tendonitis?Achilles tendonitis (also known as Achilles tendinopathy or Achilles tendinitis) is caused by inflammation of the Achilles tendon. The Achilles tendon is a piece of connective tissue found at the back of the ankle located between the calf muscle and calcaneus (heel bone). Achilles injuries are common in more physically active people. Around 7-9% of high-level runners will be diagnosed with this condition . Achilles tendonitis also occurs in roughly 1 in 5 players in the Australian Rules Football League (AFL) . It is an overuse injury caused by repetitive activities, such as running and jumping. The constant lengthening and recoiling of the tendon lead to increased inflammation. Those with Achilles tendonitis often experience pain located at the back of the ankle.
Achilles Tendonitis SymptomsThe most typical symptom of this condition is a gradual build-up of Achilles tendon pain located at the back of the ankle. Other signs that people with this condition may experience includes:
- Swelling the tendon
- Tightness along the back of the ankle and calf
- Achilles tendon pain when pushing off the toes (e.g. walking, jogging, jumping, etc.)
- Tender when touched
What Causes Achilles Tendonitis?The leading cause of Achilles tendonitis is caused by repetitive straining of the Achilles tendon. Examples of these activities include jogging, jumping and running. Intense exercise and training without proper recovery is a typical theme amongst those with Achilles tendonitis. Other factors which can increase the risk of developing this condition includes :
- Having diabetes
- Taking drugs, such as corticosteroids and statins
- Having high cholesterol (click here for more)
- Being obese
- Poor technique
- Training or exercising on hard surfaces
- Poor footwear
- Poor technique and training techniques
- Sudden increases in training volume
Tests and DiagnosisAlways consult your GP if you suspect that you have Achilles tendonitis. Early detection and treatment lead to a faster recovery. During the first consultation, your GP screens you by asking questions and assessing the injured area. Additional tests may also be needed to assist with diagnosis.
ImagingImaging assessments, such as ultrasound and MRI, can be used to look for abnormalities along the Achilles tendon. Other examinations, such as CT scans and X-rays, may also be recommended to rule out other possible causes of Achilles pain.
Achilles Tendonitis TreatmentTreatment of Achilles tendonitis generally starts by changing the approach to training and physical activity. Your GP will provide advice about the best way to speed up recovery. Often, you may need a period of rest or activity reduction. Other treatments that may be recommended include:
PhysiotherapyYour GP may initially recommend you to see a physiotherapist. These are rehabilitation health professionals specialising in managing physical conditions, such as tendon issues and muscle pain. They may provide you with a range of treatments to help improve your recovery, including:
- Corrective Achilles tendonitis exercises
- Strategies and advice about your training
- Manual therapy to help ease pain (e.g. massage, dry needling, etc.)
- Shockwave therapy
- Achilles taping
PodiatryYour GP may also recommend seeing a podiatrist. These are health professionals who specialise in managing foot and ankle problems. Alongside your GP and physiotherapist, they can offer additional treatment options, such as:
- Advice and strategies for your training
- Assessing your foot's biomechanics
- Achilles taping
- Shockwave therapy
- Recommending premade or customised orthotics for the foot
- Recommending specific footwear
Pain MedicationsPain medications, such as anti-inflammatories, may be recommended or prescribed by your doctor to help you manage your symptoms. Always follow your GP's or pharmacist's advice about the best way to take it.
SurgeryIf your symptoms do not improve with the above treatment, your GP may refer you to a foot specialist, such as an orthopaedic or podiatric surgeon. They may recommend other forms of treatment, including injections and surgery. Surgery is typically a last resort and not usually needed by someone with this condition. However, it may be appropriate for the right person, especially if symptoms have not improved with other forms of treatment.
RecoveryLike most tendon injuries, those with Achilles tendonitis will generally recover faster with early management and treatment. Having a period of rest and/or reduced physical activity may assist with recovery. More invasive treatments like surgery are generally not required but are mostly successful if needed .
ComplicationsIf left untreated, Achilles tendonitis can lead to long-term pain. Especially for active individuals, it can affect the ability to compete or perform. Loading activities, such as running, jogging and even walking, can become a challenge because of the pain. Over time, this can lead to a degenerative state where the tendon undergoes irreversible changes (e.g. breakdown of the structures, increased sensitivity, etc.).
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- Touzell, A. (2020). The Achilles tendon: Management of acute and chronic conditions. Australian Journal of General Practice, 49(11), 715-719.
- Docking, S. I., Rio, E., Cook, J., Orchard, J. W., & Fortington, L. V. (2018). The prevalence of Achilles and patellar tendon injuries in Australian football players beyond a time‐loss definition. Scandinavian Journal of Medicine & Science in Sports, 28(9), 2016-2022.
- Ackermann, P. W., Phisitkul, P., & Pearce, C. J. (2018). Achilles tendinopathy–pathophysiology: state of the art. Journal of ISAKOS, 3(5), 304-314.