The Achilles tendon is a tendon that attaches your calf muscle to your heel bone (calcaneus) and is the largest and strongest tendon in the human body – taking more force than any other joint, muscle, or tendon! The Achilles tendon allows you to move forward from standing and comes into play whenever you are accelerating, changing direction, or coming to a halt.
The result can be a rupture, usually at the point where the tendon attaches to the calcaneus. This can be a partial tear, where some of the fibers of the tendon get torn, or a complete tear, where the entire tendon comes away from the heel bone. In some cases, this also causes an allusion fracture where pieces of calcaneus bone breakaway along with the tendon.
Achilles pain is often caused due to overuse of the Achilles tendon that can cause the tendon to swell, become irritated, inflamed, and painful. It is a common sports injury that is related to running, but it can occur to anyone who places excessive stress on their feet. If you leave your affected Achilles untreated, the problem can become chronic (long-term) and make it too difficult to walk or perform your daily activities properly.
Causes & Symptoms of Achilles Pain
Several causes of Achilles pain are often rare, despite the number of types of Achilles pain that can be present after an injury. Each of the conditions below describes a different problem that is located in the Achilles tendon. One can be an acute injury, while the others are more longer-term:
This is a condition that results from untreated tendonitis. The collagen fibers that make up the tendon may break down. This degenerative damage causes tendon pain as well. It also causes scar tissues to form, which can lead to permanent thickening.
Achilles tendonitis is an inflammatory injury of the Achilles tendon. It is most commonly athletes who play sports activities that require quick twists, turning, and stops. Pain is the most common symptom that begins in the early stage of Achilles tendonitis. It is described as a burning sensation that worsens when performing the activity.
The pain can also be felt near the bottom of the calf muscle, along the tendon, or lower down closer to the heel bone. Mild swelling may come along with the pain a few minutes prior to the injury. You may feel stiffness in the morning at both the heel and calf. In addition to swelling and pain, this condition also can occur when people fail to warm up before exercising.
The tighter the calf muscles, the more tension that is placed on the Achilles tendon. Oftentimes, Achilles tendonitis is caused when a bony growth starts to develop on the back of the ankle. It may also be a Haglund’s deformity that comes from wearing ill-fitting shoes.
Achilles tendon rupture
This is more likely to be presented when the force on the tendon is much greater than the strength of the tendon. This can occur when the foot is dorsiflexed while the lower leg moves forward and the calf muscles contract. Most ruptures occur during a forceful stretch of the tendon while the calf muscles contract.
Additionally, steroids and some antibiotics are also linked to the development of Achilles tendon rupture. Many doctors avoid cortisone shots in or even near the Achilles tendon due to this association. Compared to Achilles tendonitis (in which Achilles tendonitis is irritation or inflammation of the tendon), the Achilles tendon rupture is a partial or complete tear in the tendon.
Also referred to as retrocalcaneal bursitis, is a common condition in athletes. A bursa is a tiny sac of fluid that goes in between a tendon and a bone to help the tendon move smoothly over the bone. The retrocalcaneal bursa lies between the Achilles tendon and the calcaneus (heel bone). With repeated trauma, the bursa can suddenly become inflamed. Achilles bursitis can often be mistaken for Achilles tendonitis.
The following symptoms below are associated with most types of Achilles tendon pain, such as:
The swelling at the back of the heel may make it difficult to completely bend or straighten the ankle.
There may be visible swelling located in the area of the Achilles tendon.
Warmth to the touch
If the skin at the back of the heel feels particularly hot to the touch, it may be a sign of Achilles bursitis (in severe cases, septic bursitis). Septic bursitis is a condition that is caused by an infection. Although this condition is uncommon, septic heel bursitis is a serious condition, and patients should seek immediate medical attention to ensure the infection does not spread.
There may be redness after an Achilles tendon injury. This can cause the skin of the back of the heel to appear red.
Who gets Achilles Pain?
Certain movements and regular daily habits can cause repetitive heel irritation that triggers Achilles tendon pain. Some of the risk factors below are linked to the types of Achilles pain mentioned earlier:
- Foot/ankle deformity – Bone abnormalities and other deformities increase the likelihood of developing Achilles pain. For instance, a Haglund deformity can cause extra friction between the Achilles tendon and the bursa.
- Obesity – Being overweight or experiencing a sudden weight gain can put extra pressure on the Achilles tendon.
- Sports – Athletes who play sports that involve rapid stops and turns (such as tennis, soccer, and basketball) are prone to damaging their Achilles tendon.
- Occupational laborers – People who have jobs that put stress on their feet and ankles are susceptible to developing Achilles tendonitis.
You may also be at a higher risk for Achilles pain due to having tight or weak calves, flat arches, or bone spurs.
How Does Achilles Pain Affect You? How Serious is it?
Experiencing Achilles tendon pain may lead to chronic pain that can last about 2-3 months to fully heal. You may have trouble walking or exercising, and your tendon and heel bone could become deformed.
Also, hearing a sudden “popping” sound from the back of your heel or calf is a sign of a rupture. This may lead to serious conditions which will require surgery to fix the broken heel.
Recommended Treatment & Rehabilitation for Achilles Pain
During a diagnosis of Achilles tendon pain, a doctor must rule out other possible problems, such as arthritis or a fracture. Your doctor also will try to determine if there are other contributing factors of heel pain:
Your doctor will ask about your medical history, the onset of symptoms, the pattern of pain and swelling, and how symptoms affect your lifestyle. For instance, your doctor may ask you about the type of shoes you wear and what exercise you perform. Your doctor will also likely ask if homeopathic treatments have been tried and if it helped.
Your doctor will examine your foot, noting swelling, tenderness, pain points, and range of motion. Your doctor may also ask you to point and flex your feet and stand on your toes.
If your doctor wants to rule out other conditions, medical imaging may be ordered. Some examples of imaging tests include X-rays, ultrasound, and magnetic resonance imaging (MRI). X-rays can show abnormalities of the heel. Abnormalities, such as Haglund deformity, can affect the heel’s biomechanics and increase the risk of Achilles pain. An MRI or ultrasound may be ordered if your physician suspects or wants to rule out of problem with the Achilles tendon.
After a diagnosis for Achilles pain has been done, physiotherapy may be further advised. A physiotherapist will work with you to develop an individualized treatment program to help you recover your Achilles pain. Your treatment program may include:
Your physiotherapist will help to look for possible external factors causing your Achilles pain, such as poor footwear or improper movements and exercises. He or she will then assess your footwear and recommend improvements, create a specific exercise program fit for your condition and ensure a safe return to your regular activities.
Several strategies may be included, such as applying ice to the injured heel, putting the affected leg in a brace, or using therapeutic equipment such as iontophoresis (a medical patch placed on the skin that is electrically charged and used to help decrease pain and inflammation). This pain can reduce the need for pain medication.
Also known as manual therapy, your physiotherapist may apply hands-on treatments to gently move your muscles and joints in order to improve their motion and function.
Your ankle, foot, or knee joint may be moving improperly, causing increased strain on the Achilles tendon. Therefore, self-stretching and manual therapy techniques applied to the lower body can decrease this tension and restore the full range of motion.
Muscle weakness may result in excessive strain on the Achilles tendon. Based on your condition, your therapist will design a progressive endurance program for you to help correct any weakness-associated movement errors that may be contributing to your pain.
Once your pain eases and your strength and motion improve, you will need to safely transition back into your regular activities. Based on your goals, your physiotherapist will create a number of activities that will help you learn how to use and move your body correctly to safely perform each task properly while you are recovering from your Achilles pain.
As for foot exercises, mobility, and strength are essential to keep us moving pain-free. The goal of these exercises is to strengthen the muscles in the feet and calves while improving flexibility in the Achilles tendon and plantar fascia. Here are some exercise examples you can try, including the following:
While in a standing position with the feet close together, place a tennis ball in between the heels and maintain the position of the ball by squeezing the heels together. Afterward, in a controlled motion, raise up on the toes and then return to your starting position. Complete this exercise 2 sets of 10 repetitions twice a day.
Standing calf stretch
Stand facing a wall and place your foot up against the wall. With your knee bent, lean forward until you feel a stretch in the calf closest to the wall and hold the position. Complete this stretch 2-3 times a day.
Standing gastroc stretch
Firstly, stand and place both hands on a wall. Secondly, place one leg behind the other, slightly staggered, and lean your body forward without bending the back knee until you feel a stretch in your back calf. Remember to keep the correct arch position in your foot and keep the heel on the ground. Finally, ensure both feet are facing upward before repeating the stretch 2 more times of up to 60-second holds twice a day.
Plantar fascia release
Sit in a chair to help control the pressure put on your feet. Then, take a lacrosse ball and place it under your affected foot. Apply downward pressure on the lacrosse ball with the foot. Next, stay off the heel and ball of the foot, keeping the ball inside the foot. Move the ball under your foot to find tender sports. Once you are on a tender spot, hold the position while applying pressure. Continue to massage for up to 30 seconds before repeating 2-3 times.
Alternative & Homeopathic Treatment for Achilles Pain
Below are some homeopathic treatments that can help provide a good degree of relief from pain linked to Achilles pain:
You can perform single massage techniques to soothe the pain in your heels. Use your thumbs to massage your aches and heels, working from the balls of your feet up to your heel.
While an ice cube can result in a good massage, an ice pack can also help reduce inflammation. Cover your ice pack with a cloth or thin towel and hold it over the painful area 3-4 times daily for 15-20 minutes at a time.
Try to wear shoes that provide good arch support and have a low heel, especially if you are going to be on your feet more often. This helps to support your plantar fascia and prevent them from becoming inflamed.
Gently massage your heels with this treatment product. Pure essential oils like rosemary or lavender and everyday oils such as coconut and olive oil may help reduce pain due to their anti-inflammatory properties.
Night splints help to relieve heel pain by stretching your arches and calves overnight.