Achilles tendinitis is an overuse injury of the Achilles tendon—the strong band of tissue that connects your calf muscles to your heel bone. This tendon, the largest in your body, helps you walk, run, and jump by transferring force from your leg muscles to your foot.

The condition commonly affects runners, athletes, and middle-aged adults who play recreational sports. However, it can also occur in non-athletes; research suggests that up to 30% of Achilles tendinitis cases are not related to sports activity.

Causes

Achilles tendinitis typically results from repetitive strain on the tendon. This continuous overload causes small microtears and inflammation.

Common causes include:

  • Rapidly increasing exercise intensity or duration

  • Tight calf muscles

  • Weak or structurally deformed tendons or muscles

  • Poor balance or ankle stability

  • Unsupportive footwear

  • Skipping warm-ups or stretching

  • Obesity or excess body weight

  • Certain medications (e.g., ciprofloxacin, levofloxacin, steroids)

Symptoms

Symptoms often develop gradually, starting with mild pain and stiffness that worsens with activity.

Typical symptoms of Achilles tendinitis include:

  • Pain in the heel or lower leg that worsens during activity

  • Morning stiffness or pain upon first standing

  • Tenderness and sensitivity along the tendon

  • Thickening or rigidity of the tendon

  • Pain the day after physical activity

  • Visible swelling around the heel

  • Pain when wearing shoes that press on the heel

  • Bone spurs near the tendon insertion

Seek medical attention immediately if you feel a sudden "pop" in the heel or calf—this could indicate a tendon rupture.

Diagnosis

Your healthcare provider will begin by asking questions about your pain, physical activity, and recent injuries. They may ask:

  • When do your symptoms occur?

  • What makes them worse or better?

  • What types of activities do you do?

Imaging tests—like X-rays, MRI, or ultrasound—may be ordered to evaluate the tendon’s structure and detect inflammation, tears, or bone spurs.

Treatment

Treatment focuses on reducing pain, promoting healing, and restoring strength and flexibility to the tendon.

Common treatment methods include:

  • Rest: Avoid activities that strain the tendon.

  • Ice therapy: Apply ice for 10–15 minutes several times daily to reduce pain and swelling.

  • Physical therapy: Targeted exercises can improve flexibility and rebuild tendon strength.

  • Night splints: These keep your ankle flexed to stretch your calf muscles and relieve tension.

  • Supportive footwear or orthotics: Cushioning shoes or heel lifts can help reduce tendon stress.

Medications

Your healthcare provider may recommend:

  • NSAIDs (e.g., ibuprofen, naproxen) for short-term pain and inflammation relief.

  • Nitric oxide (glyceryl trinitrate) patches, which may encourage tendon healing by promoting collagen regeneration.

  • Injections such as corticosteroids, platelet-rich plasma (PRP), or other biologic therapies to reduce inflammation and stimulate healing.

Other Therapies and Exercises

If symptoms persist despite initial care, advanced therapies may help:

  • Extracorporeal shockwave therapy (ESWT): Delivers mechanical pulses to stimulate healing; may reduce pain and improve function by up to 60%.

  • Eccentric loading exercises: The gold standard in Achilles tendinitis treatment; involves controlled stretching under tension to rebuild tendon strength.

  • Acupuncture: May help relieve chronic tendon pain.

  • Augmented soft tissue mobilization (ASTM): A therapist uses special tools to stimulate tissue regeneration.

  • Photobiomodulation (laser/light therapy): Supports tissue repair by promoting cellular energy production.

  • Surgery: Required in severe cases to remove damaged tissue or bone spurs or to lengthen tight calf muscles that restrict movement.

Prevention

Preventing Achilles tendinitis often comes down to training habits, flexibility, and proper footwear.

Prevention tips:

  • Warm up and stretch before activity.

  • Gradually increase workout intensity and duration.

  • Wear shoes with good heel cushioning and arch support.

  • Alternate high-impact activities (like running) with low-impact ones (like swimming or cycling).

  • Perform eccentric calf exercises to strengthen the tendon.

  • Avoid exercising through pain or fatigue.

Supplements and Herbs

Certain nutrients and herbal supplements may support tendon health and healing:

Common supplements include:

  • Vitamin C: Aids collagen synthesis and tissue repair.

  • Vitamin D: Supports muscle function and bone health.

  • Manganese, Copper, and Zinc: Trace minerals essential for tendon and connective tissue formation.

Herbal options sometimes used in sports medicine:

  • Ginseng: May enhance endurance and recovery.

  • Green tea extract: Contains antioxidants that protect tissues from inflammation.

  • Astragalus and Rhodiola: May help relieve joint and muscle discomfort.

Always consult your healthcare provider before taking supplements, as some may interact with medications or pre-existing conditions.

Foods and Drinks

A nutrient-rich diet helps support tendon repair and overall musculoskeletal health.

Best nutrients for tendon recovery:

  • Proteins and amino acids: Essential for tissue growth and repair.

  • Phytochemicals: Found in fruits, vegetables, and whole grains; reduce inflammation.

  • Collagen-rich foods: Bone broth, citrus fruits, and leafy greens support tendon regeneration.