Achilles Tendon Pain: What you need to know!

Your Achilles tendon is one of the most important parts of your lower extremity when it comes to functioning in everyday life. If you have ever had pain in your Achilles tendon, then you know exactly what I’m talking about!

The Achilles tendon is comprised of 3 muscles and is the largest and strongest tendon in your body. It can withstand forces 7-10 times your body weight, which can occur with high-level activities such as running. Achilles tendon pain is not only caused by major trauma nor is it only seen in professional athletes. The tendon is more likely to cause pain in the weekend warrior or those who are starting or beginning a new workout plan. 

The function of the Achilles tendon is to plantarflex the foot (pushing it towards the ground). This occurs with every step that we take and if your activity level has increased, an inflammatory response can occur. Even beginning to drive more – that repetitive motion of pushing the pedals – can irritate the tendon. A tight Achilles tendon, known as Equinus, is a major contributor to pain as well. With an Equinus deformity, there is more tension placed on the tendon. That tension, coupled with the forces of high levels of activity, is a recipe for Achilles tendinitis. 

Tendinitis is the acute response of an overload force of a tendon. This can lead to symptoms of pain, burning sensations, tightness first thing in the morning, and decreased strength and flexibility. However, the lesser-known condition of tendinosis is just as common. Tendinosis (or tendinopathy) is the chronic degeneration of tendon fibers due to overuse over time without allowing enough time for the body to recover. Either of these can occur in the Achilles tendon. The most common Achilles tendon injury we hear about is traumatic ruptures that occur from excessive plantarflexory forces. These usually occur during athletic events (as was the case with Kevin Durant) but can also occur from missteps off curbs or steps in your house.

The best way to treat Achilles tendon pain is to prevent it. Stretching before AND after physical activity is of utmost importance. Stretching beforehand will help decrease the chance of injury during that activity period and stretching after will help keep the tendon at length. If pain from tendinitis/tendinosis occurs, stretching is still important, however other treatments will also be performed. Treatment is aimed at reducing inflammation with rest, ice, and anti-inflammatory medication. Along with control of inflammation, taking the pressure off the tendon is important. In severe cases, immobilization with a boot for a couple of weeks can be very beneficial. Heel lifts can also be used which will help decrease tension on the tendon while walking. Physical therapy is also an important part of rehabilitation. Extracorporeal Pulse Activation Technology (EPAT) is an alternative, low-risk treatment to help decrease scar tissue and stimulate healing. Surgical treatment is a last resort to remove the diseased tendon. Once pain and inflammation are treated, continued stretching and proper support in shoes (inserts/custom orthotics) are key to prevent a recurrence.

If you are experiencing any of the symptoms mentioned above, it is important to see your podiatrist as early as possible. First-line treatment of rest, ice, compression, elevation (RICE) should be started immediately along with anti-inflammatory medication. Your doctor will take an x-ray to rule out any signs of stress fractures or other bone pathology. The severity of pain and symptoms will determine the aggressiveness of treatment. 

A quick note on injections. Cortisone injections are used to decrease inflammation in different parts of the body, however, should NEVER be used in tendons as it can lead to complete tendon ruptures. There are much safer ways to reduce inflammation from within a tendon.

If you think you may be experiencing any of these symptoms, call to schedule an appointment today!


Dr. Haseeb Ahmad works in our Washington, DC (1775K Street) and Silver Spring, MD (Fenton) offices for your convenience.

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