Achilles Tendon Injuries

Medically Reviewed By William C. Lloyd III, MD, FACS

What is an Achilles tendon injury?

The Achilles tendon, or the heel cord, is a strong band of tissue that connects the calf muscle to the heel. It’s the longest tendon in the body and capable of bearing significant stress. It is used when you walk, jump, climb stairs, or do anything that raises the heel off the ground. However, with overuse or injury, it can become inflamed and painful, or it could rupture.

There are several types of Achilles tendon injuries. Achilles tendinopathy can occur in two forms: either as Achilles tendinitis (also tendonitis), which develops due to overuse of the tendon, or as Achilles tendinosis, which is the degeneration of the tendon. Tendinosis can happen if Achilles tendinitis is left untreated. Achilles tendon rupture is another injury which occurs when the fibers of the tendon stretch too far and either completely or partially tear apart. This condition requires immediate medical care.

With Achilles tendinitis, you’ll probably feel pain while you’re walking or moving your calf and heel. You will feel sudden, sharp pain, often in the calf and heel if you rupture your Achilles tendon. Achilles tendon injury treatments include nonsurgical options like physical therapy and surgical options like tendon reattachment.

If you do experience symptoms of a rupture, seek medical attention right away. Call 911 if you need help.

What are the symptoms of an Achilles tendon injury?

Symptoms of an Achilles injury can occur over time, in the case of tendinitis, or suddenly, in the case of a ruptured tendon.

Symptoms of Achilles tendinitis

The most common symptoms include:

  • Stiffness in the Achilles area when you first get up
  • Pain in the back of the heel that often gets worse during activities or the day after a workout
  • Swelling that worsens as you do normal activities throughout the day
  • Difficulty flexing the foot or bending the foot downward

Symptoms of an Achilles tendon rupture

If you experience symptoms of an Achilles tendon tear, it’s important to get medical care immediately. Symptoms of torn Achilles tendon include:

  • Sudden, sharp pain in the calf and heel area
  • Hearing a popping or snapping sound when landing on the heel (at the time of injury)
  • Inability to walk normally or stand on tiptoe

A ruptured Achilles tendon can sometimes be misdiagnosed as a sprained ankle. It’s important to get an accurate diagnosis right away so you can begin proper treatment.

What causes an Achilles tendon injury?

Overuse from running or sports that require lots of running, jumping, or quick starts and stops, can irritate and injure the Achilles tendon. Increasing activity levels too quickly, not warming up and stretching before exercise or sports activities, running uphill or on uneven ground, and wearing shoes that don’t fit well can cause Achilles tendinitis. Having tight or weak calf muscles, bone spurs, or flat arches can also inflame the Achilles tendon.

An Achilles tendon rupture can occur from playing certain sports, running uphill, or running on hard surfaces. The force on the tendon from landing on your feet after falling from a height or even from stepping into a hole can tear the tendon.

What are the risk factors for an Achilles tendon injury?

Men between the ages of 30 to 50 years old are most likely to suffer an Achilles tendon injury. People who exercise or enjoy sports that involve a lot of running or jumping also have a higher risk of developing an Achilles tendon injury. Other risk factors include:

  • Playing sports involving a lot of running, jumping, or sudden changes in direction, such as soccer, basketball or tennis
  • Getting steroid injections for ankle pain and inflammation
  • Obesity which causes added stress in the area

Reducing your risk of an Achilles tendon injury

You may be able to lower your risk of an Achilles tendon injury (and other foot and ankle injuries) by:

  • Stretching and warming up before exercising or playing sports
  • Running on even surfaces, avoiding uneven surfaces
  • Slowly building up to new levels of intensity or duration of exercise and sports
  • Wearing proper footwear with plenty of cushion in the heel
  • Varying high-impact activities like running, with lower-impact activities, such as swimming or biking

It is also important to treat Achilles tendon overuse injuries so the condition doesn’t become chronic or degenerative.

How is an Achilles tendon injury treated?

Achilles tendon injury treatment depends on the severity of the injury. The goal of treatment is to reduce irritation and inflammation, which will improve symptoms. Surgery is often necessary for a tendon rupture to reattach or repair the tendon so you can walk normally.

Achilles tendinitis usually responds well to at-home treatment without surgery. However, it may take several months before you notice symptoms getting better. Waiting to seek treatment can cause further injury and a much longer recovery time. A combination of nonsurgical treatments may be your road to recovery. These options include:

  • Taking nonsteroidal anti-inflammatory drugs to reduce Achilles pain and swelling
  • Resting the tendon by using crutches or a walking boot to reduce strain
  • Icing the tendon for up to 20 minutes at a time several times throughout the day
  • Doing physical therapy exercises to stretch and strengthen the muscles and tendon
  • Wearing splints at night to stretch the tendon
  • Extracorporeal shockwave therapy, although this is uncommon because of inconsistent results

If symptoms of tendinitis persist after at least six months of nonsurgical treatment, your doctor may recommend Achilles tendon surgery to repair the tendon. An Achilles tendon rupture can sometimes be treated with nonsurgical methods, but surgery is often necessary especially for active young or middle-aged people, or competitive athletes.

What are the potential complications of an Achilles tendon injury?

Continuing to put stress on an Achilles tendon injury can cause a rupture of the tendon, or a deformity of the tendon area or heel bone. It can take up to a year for a person with an Achilles tendon injury to return to sports. Even after surgery to treat a severe injury, a person may not be able to return to running or competing.

Although Achilles tendon surgery is necessary for some injuries, it’s also possible to experience surgical complications, such as infection. Most surgeries are successful in the hands of experienced foot and ankle surgeon.

Was this helpful?
  1. Achilles Tendon Injury - Including Achilles Tendinitis and Achilles Tendon Rupture. Cleveland Clinic.
  2. Achilles Tendinitis. American Academy of Orthopaedic Surgeons.
  3. Achilles Tendon Disorders. American College of Foot and Ankle Surgeons.
  4. Achilles Tendon Injuries. Medscape.
  5. Achilles Tendon Rupture Surgery. American Orthopaedic Foot and Ankle Society.
  6. Achilles Tendon Injuries. Johns Hopkins Medicine.,215
  7. Achilles Tendinopathy. University of Virginia Health System.
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Aug 25
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