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Achilles Tendon Pain

The Achilles tendon, which connects your calf muscle to the heel bone, is at the back of your ankle. It is the largest tendon in the body and allows you walk, run, jump, and stand on tip-toe.

What causes Achilles pain?

For some people – particularly middle-aged athletes – where there is no obvious reason for it, tendon pain may be associated with arthritis or other inflammatory problems. Achilles ruptures are usually caused by training too intensively when the tendon is not strong enough.

Tendinitis, when the tendon becomes inflamed causing pain and swelling, can be caused by a number of factors including suddenly changing or intensifying your training schedule. There are two types of Achilles tendinitis:

  • Non-insertional Achilles tendinitis: this is when fibres in the middle part of the tendon break down as a result of tiny tears (this is also known as degeneration), causing them to become inflamed.
  • Insertional Achilles tendinitis: this affects the lower end of the tendon, near the heel, where it joins the heel bone. In some cases, bone spurs (bony lumps) also form on the heel bone and the fluid-filled sac behind the tendon (bursa) can become inflamed – this is known as bursitis. Insertional tendinitis can affect anyone, even if they are not very active.

What are the signs of Achilles tendon pain?

Signs and symptoms include:

  • Thickening of the tendon
  • Pain and stiffness – especially in the morning
  • Pain at the back of the leg near the heel, along with swelling, which becomes worse with – or after – exercise
  • Bone spur (in insertional tendinitis)
  • Swelling that gets worse with activity

It’s important to get advice as soon as possible as your symptoms may become worse.

How is Achilles pain diagnosed?

During your first appointment, you’ll have an opportunity to discuss your symptoms with Mr Heidari who will usually carry out a number of diagnostic tests. These may include an X-ray or an MRI scan to discover the extent of any damage to the tendon.

What does treatment involve?

Not everyone with Achilles pain needs to have surgery. In many cases, resting and taking anti-inflammatory painkillers (if advised by your doctor), combined with a tailored rehabilitation programme working with one of our physiotherapists, is all that’s needed to reduce the pain.

Mr Heidari may suggest that you have a course of steroid injections to reduce the inflammation. You may also find that wearing heel lifts are helpful (particularly if you have insertional tendinitis) to take strain away from the tendon; specially designed supportive walking boots can also help.

If the tendon pain doesn’t improve, Mr Heidari may suggest carrying out an operation to remove any bone spurs (bony lumps). In some cases, if the tendon is very seriously damaged, you may be offered tendon transfer surgery which involves relocating another tendon in your foot to support the damaged Achilles tendon.

This information is written as a guide to your treatment but it is not intended to replace the advice of your doctor. Please contact us for advice if you are worried about any aspect of your health or recovery.