Achilles tendonitis: Prevention and treatment

Achilles tendonitis is an overuse syndrome associated with the calf muscles and the heel.

The Achilles tendon is made up of the lower end of the two muscles in the calf on the back of the lower leg. These muscles assist in knee movement, and because they attach to the heel, they also move the foot.

Achilles tendonitis is typically associated with foot movement. Pain with walking can be described as burning and radiating through the entire tendon. There may be some tightness in the tendon and calf muscles, and the area will be tender to the touch. Inflammation, warmth around the area and swelling are all common signs for Achilles tendonitis.

The main cause of Achilles tendonitis is repeated over-stretching movements in the calf muscle, which lead to micro tears that, over time, can cause chronic inflammation and eventually degeneration of the tissue.

Other causes include tight hamstring muscles, tight calf muscles, a high foot arch, poor foot biomechanics, poor training mechanics, running on uneven surfaces and improperly fitted footwear that does not adequately stabilize the heel.

Management of Achilles tendonitis is very conservative:

  • RICE (Rest, ice, compression, elevation)
  • NSAIDs (Non-steroidal anti-inflammatory drugs) such as ibuprofen
  • Analgesics such as acetaminophen (Tylenol)
  • ROM (Range of motion) exercises for 1-3 weeks
  • PRE (Progressive resistive exercises) for 1-3 weeks
  • Heel lift/gel insert

Prevention of Achilles tendonitis can be as simple as using:

  • An orthotic device to correct foot alignment.
  • A 10-15 mm heel lift to decrease the tendon stretch.
  • A flexible shoe and an Achilles pad to prevent irritation from friction.

Tips from the ATC:

I have found that athletes do not typically like to hold an ice pack to their leg, so I have had better luck with immersion. Filling a Rubbermaid tub or garbage can with ice and water allows the entire area to be completely surrounded, thereby reducing pain and swelling. Ice by immersion for 10-15 minutes tends to be terribly cold at first, but after a few minutes, the analgesic effects hit. My athletes prefer it to ice packs.

Joni Canter, MBA, ATC, is a certified athletic trainer with Prisma Health’ss ATC Network. The ATC Network, one of the largest athletic training networks in the country, serves over 50 middle schools and public and private high schools in addition to providing services for a professional baseball team, university athletics, recreation districts and national events held in the Upstate of South Carolina. 

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