• Achilles tendonitis

    Achilles tendonitis is inflammation and pain at the Achilles tendon (back of the ankle). This tendon, also known as the heel cord, is the tendon attachment of the calf muscles from the leg and knee to the heel. This tendon is important when standing on your toes or in the pushing-off phase of walking, running, or jumping.

    Achilles tendonitis is usually a grade 1 or 2 strain of the tendon. A grade 1 strain is a mild strain. There is a slight stretch of the tendon but no obvious tendon tearing. (There is some microscopic tendon tearing.) There is no loss of strength, and the tendon stays the correct length. A grade 2 strain is a moderate strain. There is tearing of tendon fibers where the tendon attaches to muscle or bone. The length of the tendon or whole muscle-tendon-bone unit is increased, and there is usually decreased strength. A grade 3 strain is a complete rupture of the tendon.

    Common signs and symptoms

    Notify a physician if any of these symptoms do not resolve within two weeks: 

    • Pain, tenderness, swelling, warmth, and redness over the Achilles tendon.
    • Pain with ankle motion (especially pushing off or pushing down with the front of the foot) or standing on the ball of the foot or toes.
    • Crepitation (a crackling sound) when the tendon is moved or touched.


    Initial treatment consists of ice to relieve the pain, stretching and strengthening exercises, and modification of the activity. These can be carried out at home, although referral to a physical therapist or athletic trainer for further evaluation and treatment may be helpful. Occasionally a walking boot or cast may be recommended to immobilize the tendon, allowing the inflammation to settle down. For less severe cases or after immobilization, a heel lift may be prescribed to reduce stress to the tendon. This may be followed by an elastic wrap of the ankle and Achilles tendon. Orthotics (arch supports) may be prescribed or recommended by your physician.

    RICE Principle
    With all acute injuries, follow the RICE principle to reduce swelling, pain and inflammation.

    Rest - Walk with crutches if you cannot bear weight.
    Ice - Use an ice pack for 20 minutes every two to three hours during the first 72 hours.
    Compression - Use an ace wrap on the ankle. Start at the bottom of the toes and wrap up to mid-calf.
    Elevation - Keep the injured ankle above the level of your heart when sitting or lying down

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