By the Fitness Chiropractic team · Updated
What is Achilles tendonitis?
The Achilles tendon is the thick cord that connects your calf muscles to your heel bone. It's the largest tendon in the body and takes a huge load every time you walk, climb stairs, jump or push off to run.
Achilles tendonitis (also spelled tendinitis) is pain and irritation of that tendon caused by more load than it can recover from. When symptoms have been around for a while, the problem is usually less about inflammation and more about changes in the tendon tissue itself, which is why you may also hear it called Achilles tendinopathy.
There are two common types:
- Mid-portion Achilles tendonitis, felt a few centimeters above the heel, often with some thickening of the tendon
- Insertional Achilles tendonitis, felt right where the tendon attaches to the back of the heel bone
Achilles tendonitis symptoms
Achilles tendon pain usually builds gradually. Common signs include:
- Pain and stiffness along the back of the heel or lower calf, often worst first thing in the morning
- Pain at the start of a run or walk that may ease as you warm up, then returns afterward
- Tenderness when you squeeze the tendon, sometimes with swelling or a thickened area
- Pain going up stairs or hills, or when rising onto your toes
What causes Achilles tendon pain?
The most common trigger is a sudden increase in activity — more miles, more hills, faster sessions or a new sport — without giving the tendon time to adapt. Other contributors include:
- Running and jumping sports such as basketball, soccer, tennis, volleyball and dance
- Tight or weak calf muscles
- Worn-out shoes, or a sudden switch to flatter or minimalist footwear
- Foot mechanics, such as a foot that rolls in heavily when you walk or run
- Age — it's more common in middle-aged and older adults, including weekend athletes
- Certain medications, notably a class of antibiotics called fluoroquinolones
Runners can find more on training errors in our article on how to avoid running injuries.
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How we assess Achilles tendonitis
Your first visit includes a full orthopedic and neurological exam. We check where along the tendon the pain sits, how your calf strength compares side to side, and how your ankle, knee and hip move. We also watch how you stand, walk and rise onto your toes.
Imaging is rarely needed for typical Achilles tendonitis. If your history or exam suggests a tear or another problem, we'll refer you for the right tests.
How our chiropractors treat Achilles tendonitis
Complete rest tends to weaken the tendon further, so the goal is the right amount of load rather than none at all. As part of our sports injury treatment care, your plan may include:
- Load management — temporarily reducing running volume, hills and jumping while keeping you as active as your tendon allows
- Progressive tendon-loading exercises, starting with calf holds and building to slow heel raises, with variations for insertional pain
- Soft-tissue therapy and massage therapy for tight calf muscles
- Ankle and foot joint mobilization where stiffness is changing how load passes through the tendon
- Gait analysis and custom orthotics — we use the Footmaxx system to scan how your foot moves and order custom foot orthotics when your foot mechanics are adding strain
- Strength and balance work for the hips and legs, so the load is shared more evenly
Heel pain on the underside of the foot is a different problem, covered on our plantar fasciitis page. You can read about our wider approach on our chiropractic treatment page.
Recovery and prevention
Achilles tendonitis often takes weeks to months to settle, and longer-standing cases can take longer. A useful rule of thumb is that some discomfort during exercise is acceptable if it settles by the next morning and doesn't build week to week.
To lower your risk of it coming back:
- Increase training gradually and avoid big jumps in distance or intensity
- Keep up calf strengthening exercises even after the pain has gone
- Replace running shoes before they're badly worn
- Mix high-impact sports with lower-impact activity such as swimming or cycling
- Ice the area for 15 minutes after activity if it eases soreness
When to seek urgent medical care
Get prompt medical care if you feel a sudden pop or snap at the back of the ankle — some people describe it as being kicked in the heel — followed by trouble walking, pushing off or standing on your toes. This can be an Achilles tendon rupture, which needs to be assessed quickly.
Also seek medical attention for:
- Calf swelling, warmth, redness or tenderness, particularly after a long flight, surgery or a period of immobility, which can be a sign of a blood clot
- A red, hot, swollen heel or a fever
- Pain that keeps you from bearing weight
For the gradual, nagging ache above your heel, a chiropractic exam is a sensible first step. Achilles tendonitis is one of the many conditions we treat.
