Achilles tendonitis is a common cause of pain at the back of the heel and lower leg. The Achilles tendon connects the calf muscles to the heel bone, and irritation or overuse can cause pain, tightness, and swelling. Most cases improve with conservative care, and early treatment helps protect the tendon from more serious damage.
Most people improve with conservative treatment that calms the tendon and then rebuilds its strength.
Conservative care
When pain persists
Surgery is rarely needed for tendonitis. It is reserved for a torn tendon or symptoms that do not improve after months of conservative care.
Achilles tendonitis usually builds up from repeated stress rather than a single injury. Common causes and risk factors include:
Overuse
Running, jumping, and court sports, especially with a sudden increase in training.
Tight calf muscles
Add strain to the tendon with every step.
Foot mechanics
Flat feet or rolling in can stress the tendon.
Footwear
Worn-out or unsupportive shoes.
Heel bone spurs
Can rub and irritate the tendon at its attachment.
Age
Tendons lose flexibility and blood supply over time.
Where the pain is felt helps guide treatment.
Middle of the tendon
Noninsertional tendonitis
Pain a few inches above the heel.
At the heel bone
Insertional tendonitis
Pain where the tendon attaches to the heel.
Both types usually improve with conservative care. A sudden pop, snap, or weakness in the back of the ankle may mean a tear and needs prompt evaluation.
Achilles tendonitis (also spelled tendinitis) is irritation and inflammation of the Achilles tendon, the large tendon that connects the calf muscles to the heel bone. It is usually caused by overuse.
Tendonitis describes active irritation and inflammation. Tendinosis describes longer-term wear and breakdown of the tendon fibers. Both cause pain and stiffness and are treated in similar ways.
Pain is felt along the back of the leg just above the heel (midportion tendonitis) or where the tendon attaches to the heel bone (insertional tendonitis).
Morning stiffness is a hallmark of Achilles tendonitis. The tendon tightens overnight, and pain often eases as it warms up, then returns after activity.
Running through the pain can make it worse and raise the risk of a tear. Reducing or changing activity while the tendon calms down, then returning gradually, is safer.
Mild cases often improve in several weeks. Longer-standing tendonitis can take several months of consistent stretching, strengthening, and activity changes.
A weakened, degenerated tendon is more likely to tear. A sudden pop or snap in the back of the ankle, followed by weakness, needs prompt evaluation.
Rarely. Surgery is considered when months of conservative care have not helped, when the tendon is badly degenerated, or when it has torn.
Symptoms often start mildly and worsen with continued activity. They may include:
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