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How To Diagnose & Treat Painful Achilles Tendinitis

The body responds to injuries or diseases through inflammation. Thus, Achilles tendonitis is the body’s response to an injury in the Achilles tendon. There is an increasing incidence of this health issue in the US, from 1.8 in 2012 to 2.5 in 2016 per 100,000 person-years. Health professionals must understand several diagnostic and treatment options to handle this issue adequately and deal with its increasing incidence.

What is Achilles Tendonitis?

Achilles tendonitis is a health issue involving the inflammation and irritation of the Achilles tendon. This tendon connects the heel bone to the calf muscle at the back of the heel and is critical for walking, running, and jumping since it enables the heel to get off the ground.

The primary cause of Achilles tendonitis is running and jumping-related Achilles tendon stress or overuse. This repeated stress or overuse of the tendon gives the body limited time to repair injured tissues leading to inflammation or irritation.

Patients with the condition experience significant levels of pain. Leaving Achilles tendonitis untreated over a prolonged period can result in long-term problems such as walking difficulties. 

Types of Achilles Tendonitis

Noninsertional and insertional are the two basic types of Achilles tendonitis in light of the affected tendon part. Patients with noninsertional Achilles tendonitis experience breakdown, swelling, or thickening of the fibers in the middle of the Achilles tendon. This tendonitis type is more common in younger and more active people.

Conversely, patients with insertional Achilles tendonitis experience inflammation at the lower part of the heel where the tendon connects or inserts into the heel bone. Everyone, including non-active people, is susceptible to insertional Achilles tendonitis. However, the condition is most common in people that overuse the tendon, especially long-distance runners.

Symptoms of Achilles Tendonitis 100

Some common symptoms of Achilles tendonitis include:

  • Weakness of the leg
  • Persistent heel and ankle pain
  • Swelling around the Achilles tendon
  • Increased stiffness or tenderness of the tendon
  • Pain on the back of the heel when wearing shoes
  • Pain worsens with physical activities
  • Increased discomfort after climbing or walking uphill
  • Morning discomforts at the Achilles tendon

Risk Factors of Achilles Tendonitis

People highly susceptible to Achilles tendonitis include:

  • Sportsmen/women, especially in sports that require quick starts and stops
  • Runners
  • Dancers
  • Laborers whose jobs excessively stress their feet and ankles
  • Leisure sport participants (i.e., people who participate in sports less frequently)

It is noteworthy that the body's anatomy significantly affects susceptibility to Achilles tendonitis. Some body shapes and structures at high risk of this condition include:

  • Flat arches
  • Tight or weak calf muscles
  • Overpronation (or ankles  that roll down and in when walking)
  • Bone spur (or extra bone growth in the heel), which rubs the tendon to cause pain

Diagnosing Achilles Tendonitis

Diagnosing Achilles tendonitis includes a preliminary physical examination involving pressing the affected area to determine the pain location, swelling, or tenderness. Professionals must also identify the presence of relevant signs and symptoms.

Moreover, health professionals must ascertain the flexibility, range of motion, alignment, and reflexes of the foot and ankle of the patient. The limited range of motion of the ankle is a pointer of Achilles tendonitis, specifically when the patient exhibits a decreased ability to point toes downward.

In most cases, professionals require patients to carry out follow-up imaging tests to confirm that the identified symptoms are Achilles tendonitis-based and ascertain the severity of the condition.  These imaging tests include x-rays, ultrasound, and magnetic resonance imaging (MRI).


X-ray imaging allows professionals to narrow down the conditions that can cause similar symptoms. Although this imaging test is unsuitable for visualizing soft tissues, such as tendons, it is ideal for diagnosing Achilles tendonitis.


Unlike x-rays, ultrasound can visualize tendons using sound waves. Moreover, professionals can obtain real-time images of the tendon in motion using this device and evaluate the flow of blood around the tissue using a more advanced color-Doppler variant.

Magnetic Resonance Imaging (MRI)

MRI machines leverage radio and magnetic waves to produce highly detailed images of the Achilles tendon to identify inflammation or irritation. MRI is also essential for planning surgical procedures by giving a visual presentation of the severity of the damage in the tendon.

Treatment Options for Achilles Tendonitis

While self-care measures, such as wearing supportive shoes, avoiding extreme sports or activities, and muscle stretching, are effective in addressing Achilles tendonitis, professionals can prescribe other surgical and nonsurgical treatment options. These treatment options include physical therapy, medications, and surgical procedures.

Physical Therapy

Physical therapy is a recurrent treatment option for Achilles tendonitis. Therapists may prescribe exercise or orthotic devices, depending on the severity of the condition. Stretching and strengthening exercises can significantly improve the tendon and its supporting structures. Eccentric strengthening, a form of physical therapy, can eliminate persistent Achilles tendonitis.

Therapists can also prescribe orthotic devices, such as shoe inserts or wedges, to slightly elevate the heel and relieve strain on the tendon. Moreover, these devices can adequately minimize the force exerted on the Achilles tendon.


Antiinflammatory and pain relief drugs, such as Advil, ibuprofen, naproxen, Motrin IB, and Aleve, can significantly improve the experience of a patient suffering from Achilles tendonitis.


Professionals opt for surgical procedures when conservative and non-surgical options do not efficiently address the condition. The surgical procedures commonly involve repairing the Achilles tendon to eliminate the damage and promote healing.

Bottom Line

The Achilles tendon is susceptible to tear and injury due to excessive stress and overuse. While the condition is common in physically active people, non-active people also experience it since their body systems are unaccustomed to certain stress levels. In addition to physical examination, professionals can order image tests, such as x-ray, ultrasound, and MRI, to adequately diagnose the presence of Achilles tendonitis. Moreover, the professionals can leverage surgical procedures and nonsurgical treatment options, such as physical therapy and medications, to address Achilles tendonitis.

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