Health Topics for Sports Medicine

Department of Orthopaedic Surgery

UI Family Care

Achilles tendonitis

Achilles tendonitis is irritation and swelling of the Achilles tendon. The Achilles tendon is the largest tendon in the body and connects the calf muscles to the heel bone. It can withstand up to eight times the weight of the body.

Achilles tendonitis is usually the result of overuse or an injury. Overuse is often the result of poor training or exercise. There are some diseases that may contribute to tendonitis, such as arthritis or an infection. Most tendonitis is probably caused by a combination of factors. Even the wrong kind of shoes or worn out shoes may be part of the problem.

Achilles tendonitis starts slowly and takes a long time to treat. It is most common in runners, but dancers, walkers, and tennis players have it also. Achilles tendonitis starts with pain and tenderness over the heel. At the start of exercise there may be pain, stiffness, or a sluggish feeling. The pain may be less as the exercise continues. It may return after the exercise is over and may be worse with very strenuous exercise.

If not treated the tendonitis will get worse and the tendon will weaken. This may cause it to rupture. If this happens, surgery will be necessary. For this reason, anyone having pain in or above the heel needs to see a healthcare provider.

The treatment starts with rest of the affected area. There should be no weight bearing activity (such as standing and walking) until evaluated by the provider. The exercise or activity that seems to be causing the symptoms should be stopped. The activity may need to be stopped for 3 to 4 weeks. Cloth-covered ice packs may be put on the heel for no more than 20 minutes 4 to 8 times a day. Non- steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen may be used. Aspirin or medicines that have aspirin in them should not be given to anyone younger than 18 years of age. Taking aspirin is a risk for a serious illness called Reye's syndrome. NSAIDs should be taken with food or milk to prevent stomach upset. NSAIDs should not be taken by anyone who has been diagnosed with asthma, ulcer disease, or a bleeding disorder. Taking NSAIDs increases the risk of bleeding with trauma, dental work, surgery, or if taking blood thinners (anticoagulants).

Physical therapy is useful for stretching and strengthening the calf muscles and the tendon. When the activity can be started again, orthotics and heel wedges may be necessary for good body alignment. Shoes should be specific for the sport and have good arch supports. There needs to be a good cushion for the sole, especially in the heel area. When exercise is started again, a slow, gentle warm-up is very important. Runners need to increase speed and distance very slowly.

Even with treatment, the symptoms may last 3 to 4 months. Sometimes a cast is put on the foot to rest it. If the symptoms do not get better after about 4 to 6 months, surgery may be necessary.

Last Reviewed 2005

Disclaimer: This content is reviewed periodically and is subject to change as new health information becomes available. The information provided is intended to be informative and educational and is not a replacement for professional medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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