Achilles Tendonitis / Tendonopathy

August 13th, 2022

Achilles Tendon

  • thickest tendon in body and very strong
  • attaches calf muscles to heel bone
  • covered by sheath that lubricates tendon

Achilles Tendonitis

  • when cold, increased viscosity of lubricant within sheath reduces lubricating properties
  • friction of repetitive movement of tendon within sheath, especially during cold weather or in absence of warm-up prior to intense activity, provokes inflammation within tendon
  • crepitus, a crackling sensation, may be felt as inflamed surfaces interact with movement
  • chafing of tendon against sheath causes thickening of opposing tissues
  • nodule, often found at level of top of shoe heel cup, may form in tendon due to friction irritation

Physical Therapy Treatment

  • application of electrotherapeutic modalities
  • vigorous massage of tendon and calf muscles may be indicated
  • icing (ice acute injury for at least 48 hours and continue to ice if swelling persists)
  • stretching (most effective following short warm up and immediately after activity or sport) and strengthening exercises are demonstrated and assigned as home routine
  • heel lifts are used in commencing return to activity and may be removed after pain has abated
  • custom-fabricated orthotics (insoles) or prescription shoes or sandals may be prescribed to remedy faulty foot-ankle biomechanics
  • use of taping may help in situations in which physical demands of resumed activity are high and/or rapid return to activity is necessary
  • splint may be used to keep tendon on stretch overnight
  • conditioning and functional re-training activities assigned if normal routine of daily living has been negatively impacted by this condition

Other Treatments

  • your physician may prescribe oral or topical anti-inflammatory (ultrasound may assist in absorption and dispersion of topically applied anti-inflammatory medication)
  • Prolotherapy, injection directly into tendon, is occasionally employed by physician to cause tissue thickening to shrink
  • Lithotripsy, pulsed high intensity ultrasound waves (also used to break up kidney stones) may be tried if problem is unrelenting
  • surgical debridement of severe scar tissue very occasionally indicated; may be considered a last resort
  • cortisone injection employed only with extreme caution as incidence of spontaneous rupture following injection is high


  • condition can severely limit activity level of sufferer and where there is marked amount of pain activity level should, in fact, be reduced as much as possible
  • ballistic activities such as tennis, squash, and running are most affected
  • condition responds well to treatment with mild cases requiring four or five sessions to resolve
  • generally, larger swelling indicates longer recovery period
  • pain-free nodules may not necessitate reduction in level of activity
  • check with your therapist for suggestions for safe and effective gradual return to activity as overly ambitious return to activity may cause relapse

Physio Note: Footwear

Running shoes with worn-out soles may subject tendon to prolonged excessive stretch

Examine your running shoes periodically for degree and pattern of wear and correct alignment

Your physical therapist can help you recognize footwear faults