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Staying active can be challenging even in the best of times. Adding an ankle or foot injury to the mix effectively halts exercise and activity. Some injuries are no more than temporary nuisances, but others, such as Achilles tendonitis, might take months to recover. The good news is that the Achilles tendon will heal. Learn more about the condition and treatment of Achilles tendonitis below.
What is Achilles tendonitis?
Achilles tendonitis (or Achilles tendinopathy) is an inflammation of the Achilles tendon due to repetitive overuse of the tendon or mechanical stress. The inflammation causes pain and limits the use of the tendon and attached muscles.
The Achilles tendon connects the two major calf muscles of the leg to the back of the heel bone, or calcaneus. One of these muscles, the gastrocnemius, flexes the knee, pivoting the calf to the back. Both muscles flex the heel downwards. These two actions, pulling the calf back and pushing the foot down, are critical to walking, running, and jumping. The Achilles tendon takes a lot of mechanical strain all day long, particularly in people with active lifestyles. For this reason, it is the strongest and largest tendon in the body.
The Achilles tendon is made of tough, fibrous tissues that both absorb the stress of leg movements and store energy like a spring. When walking or running, the Achilles tendon compresses whenever the foot strikes the ground. When the foot leaves the ground, the Achilles tendon quickly releases that compressed energy, giving the entire body a push.
Healthcare providers distinguish between Achilles tendon pathologies as Achilles tendonitis—inflammation of the Achilles tendon—or Achilles tendon injuries, such as Achilles tendinosis and Achilles tendon rupture.
Achilles tendinosis is a chronic degeneration of the Achilles tendon fibers due to small tears in the tendon tissues. The tendon itself becomes thicker and stiffer but does not swell.
Achilles tendon rupture is a severe and sometimes debilitating injury in which the Achilles tendon tears either partially or all the way through. Achilles tendon rupture happens suddenly and is often the result of an injury caused by the sudden or explosive movement of the heel, such as pivoting hard on one foot during a tennis or basketball game.
How is Achilles tendonitis diagnosed?
Achilles tendonitis is diagnosed primarily through a physical examination of the injury and medical history. Imaging tests may be necessary to assess the injury and rule out other injuries.
In the first visit, an orthopedist or primary care physician will try to determine the nature of the injury. Be prepared to answer the following questions:
- When did the pain start?
- What part of the Achilles tendon hurts?
- What activities cause pain in the Achilles tendon?
- When does the pain start, at the beginning of an activity or later?
- Does the pain diminish or worsen during activities?
- Has the Achilles tendon been injured or painful before?
You may be asked to fill out a Victorian Institute of Sports Assessment (VISA-A), a questionnaire that asks detailed questions for active people about Achilles tendon pain.
The medical history will also help identify risk factors for Achilles tendonitis. People most at risk for Achilles tendonitis are athletes (particularly runners), sports participants, and people with active lifestyles or jobs. Other risk factors include:
- Age
- Use of certain types of medications, such as corticosteroids or fluoroquinolones
- Metabolic disorders such as diabetes, rheumatoid arthritis, or high cholesterol
- Excess weight
- Improper footwear
- Walking or exercising on hard surfaces
- Inadequate warm-ups and stretching before exercise
In a physical exam, the healthcare professional will look for swelling and tenderness. The doctor will test for localized tendon pain by gently squeezing areas of the tendon with the foot in different positions. The doctor may also squeeze the calf muscle to test for tendon rupture. The range of heel motion will be tested and the doctor may want to observe gait.
An X-ray, ultrasound, MRI (magnetic resonance imaging), or CT scan may be used to rule out other conditions, such as Achilles tendinosis or Achilles tendon rupture.
Achilles tendonitis treatment options
Tendons heal very slowly, particularly the Achilles tendon. Treatment may last three to six months before the tendon returns to full functionality. Achilles tendonitis treatment aims to reduce the risk of further injury, manage the pain, and return the tendon to normal function. The most common treatment to achieve these goals is to rest and exercise. Orthotics can help maintain proper ankle alignment, and over-the-counter medications can help control pain and swelling.
Conservative therapies
Achilles tendonitis will heal on its own with activity reduction (called relative rest), footwear changes, calf massage, icing, elevation, and compression.
Exercise
The gold standard for Achilles tendon treatment is a daily regimen of eccentric exercises along with other conservative therapies. Eccentric exercises and stretching gradually increase the ability of the tendon to handle loads. They include standing on tiptoes, heel lifts, heel drops, and stretches, all while supporting the body’s weight against a wall. An eccentric exercise program typically takes three to six months to complete.
Medications
The pain and swelling of Achilles tendonitis can be relieved by over-the-counter NSAIDs (nonsteroidal anti-inflammatory drugs) and other pain relievers, such as acetaminophen. For more debilitating tendon pain, a doctor may inject a corticosteroid to provide rapid symptom relief.
Support
Support devices can significantly help the tendon healing process. A podiatrist can help design custom orthotics that can significantly reduce Achilles tendon pain by keeping the Achilles tendon from twisting when walking or standing. Ankle braces support proper foot and ankle alignment when walking, sitting, or standing. Support socks not only help maintain ankle alignment but also stimulate blood flow to the tendon. Finally, night splints immobilize the ankle during sleep.
Extracorporeal shockwave therapy
If conservative treatment doesn’t work, orthopedic specialists will try extracorporeal shockwave therapy (ESWT) to ease pain and help restore the tendon’s functionality. ESWT sends a high-energy sound wave at the tendon and may work by killing nerves in the tendon.
Surgery
Surgery is offered for the 10-30% of cases that do not improve after six months. An orthopedic surgeon will remove the damaged part of the tendon and stitch the tendon together. The success rate is 70%, but the surgery often involves complications.
Achilles tendonitis medications
Medications are only used to reduce pain and swelling caused by Achilles tendonitis. No medication cures Achilles tendonitis or speeds up the healing process.
NSAIDs (Non-steroidal anti-inflammatory drugs)
NSAIDs reduce the swelling and pain in the Achilles tendon. Over-the-counter oral or topical NSAIDs, such as ibuprofen, naproxen, aspirin, or topical trolamine, ease swelling and help restore most function. More severe pain can be treated with more powerful prescription NSAIDs. Patients with bleeding or gut problems will be prescribed celecoxib, an NSAID that does not interfere with blood clotting. Those patients with heart disease and kidney damage, should use NSAIDs cautiously after discussing with their physician. Acetaminophen, an over-the-counter pain reliever, can be used by people who are unable to take NSAIDs.
Corticosteroids
Steroid injections are reserved for debilitating pain or serious loss of function due to Achilles tendonitis. The doctor will inject a small dose of methylprednisolone, cortisone, or other corticosteroid along with an anesthetic such as bupivacaine directly into the affected area of the tendon. Pain and symptom relief are usually immediate and can last for up to six weeks.
What is the best medication for Achilles tendonitis?
Achilles tendonitis medications relieve pain and swelling. If a patient can achieve sufficient pain relief from activity modification, icing, and support devices, then the best medication is no medication at all. If not, the most commonly used medications for Achilles tendonitis pain relief are over-the-counter NSAIDs, but there is no “best” medication for Achilles tendonitis.
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| Best medications for achilles tendonitis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Motrin (ibuprofen) | NSAID | Oral | Two tablets every four hours | Nausea, bleeding, stomach pain |
| Aleve (naproxen) | NSAID | Oral | One 220 mg tablet taken with food or water every eight to 12 hours | Nausea, bleeding, stomach pain |
| Aspirin | NSAID | Oral | One or two 325 mg capsules or tablets with water per day | Upset stomach, heartburn, bleeding |
| Myoflex (trolamine salicylate) | NSAID | Topical | Apply to the affected area three to four time a day | Nausea, upset stomach, skin irritation |
| Celebrex (celecoxib) | Prescription NSAID | Oral | One 200 mg capsule daily | Abdominal pain, diarrhea, stomach upset |
| Tylenol (acetaminophen) | Analgesic | Oral | Two tablets every four hours | Nausea, stomach pain, loss of appetite |
| Depo-Medrol (methylprednisolone acetate) | Corticosteroid | Injection | 1/16 to 3/8 ml injection of 80 mg/ml solution | Mood changes, edema, increased blood pressure |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of Achilles tendonitis medication?
Achilles tendonitis medications have several side effects that can vary based on the type of medication. This is not a complete list of possible side effects, so you should consult with a healthcare professional if you have concerns about possible side effects or drug interactions.
The central issue with NSAIDs and other pain relievers is that the pain relief they provide gives the illusion of “fixing” the Achilles tendonitis. The pain relief may lead the patient to resume physical activities that continue to damage the tendon, rather than resting the tendon to allow it to heal. The most common side effects of NSAIDs, such as stomach problems, ulcers, digestive system problems, bleeding, and bruising, are related to the way NSAIDs interfere with blood clotting.
Corticosteroids produce side effects such as mood and behavior changes, increased appetite, weight gain, acne, and elevated blood pressure. However, only a small, one-time-only corticosteroid dose is used to treat Achilles tendinopathy. It is injected directly into the swollen part of the Achilles tendon, so patients will experience only mild side effects if any.
What is the best home remedy for Achilles tendonitis?
For the first few days after a diagnosis of Achilles tendonitis, or during the day or two following a flare-up, the standard home remedy is RICE: Rest, Ice, Compression, and Elevation.
Rest
Rest the injured area by halting activities that caused the tendon injury. Give the tendon one or two days of total rest followed by limited activities for the next few weeks.
Ice
Pain and swelling can be managed by applying ice packs or massaging the tendon area with ice. Discontinue icing the tendon three days after the pain and swelling first start.
Compression
Use a compression bandage, tape, or ankle brace to limit the movement of the ankle and maintain proper alignment of the foot and ankle. There are several compression devices specifically made for Achilles tendonitis such as compression sleeves and support socks.
Elevation
For the first few days, elevate the foot to the level of the chest. This helps drain blood from the foot and reduce swelling.
Exercise
The Achilles tendon requires exercise to rebuild strength and flexibility. Stretching and progressive eccentric exercises are the gold standard treatment for Achilles tendonitis. Heel raises, heel drops, and standing on tiptoes while supporting your weight against a wall are the proven way to come back from a swollen Achilles tendon.
Activity modification
“Relative rest” is the standard therapy for Achilles tendonitis in the weeks or months it takes for the tendon to heal. Activities that strain on the tendon, twist the tendon, or throw the foot out of alignment should be carefully avoided and only gradually reintroduced. Relative rest may mean walking rather than running or swimming rather than tennis. Only gradually increase activities over the next few weeks. Dial activities back if pain or swelling flares up again.
Frequently asked questions about Achilles tendonitis
How long does it take to heal Achilles tendonitis?
Tendons heal very slowly. This is especially true of the Achilles tendonitis because it tends to get injured in a location that receives poor blood flow. On average, most people should recover full function and range of motion in three months, but the condition could drag on for as long as six months.
Does Achilles tendonitis ever go away?
Achilles tendonitis can go away in as little as six weeks. Most people recover full function in about three months, but some cases may go on longer.
Will Achilles tendonitis heal on its own?
In all cases, a swollen Achilles tendon will heal on its own. The healing process must be nurtured, however, by rest and modifying activities that interfere with the healing process, such as running.
What is the best medicine for tendonitis?
Achilles tendonitis is not treated with drugs. Instead, medications such as NSAIDs (nonsteroidal anti-inflammatory drugs), pain relievers, and, in extreme cases, corticosteroids can help reduce swelling and pain while the tendon heals itself.
What happens if Achilles tendonitis goes untreated?
Achilles tendonitis can develop into more serious and even permanent conditions if the injury is not properly cared for. The tendon needs weeks or months to heal itself, so rest and activity modification are critical. If too much strain is continually applied to the tendon, it will develop small tears that can eventually lead to chronic tendinosis or a tendon rupture, in which the tendon partly or completely tears itself in two.
What medication causes Achilles tendonitis?
Some medications can cause the Achilles tendon and other tendons in the body to swell or even tear. These include fluoroquinolone antibiotics, such as ciprofloxacin, corticosteroids, statins, and breast cancer drugs called aromatase inhibitors.
What is the fastest way to heal Achilles tendonitis?
There is no fast way to heal Achilles tendonitis. The tendon needs time to heal itself. It’s important to rest the tendon, reduce activities, and do stretching and eccentric exercises that help the tendon regain strength and pliability. If there is pain, NSAIDs help with symptoms.
Is walking good for Achilles tendonitis?
The Achilles tendon requires exercise and use to recover from Achilles tendonitis. Low-impact exercises such as walking, swimming, or riding a bicycle help the tendon recover its full function. Let pain be the guide. If walking hurts the tendon, then switch to an activity that puts less strain on the tendon, such as swimming or aquatic exercise. For Achilles tendonitis, if there’s pain, there’s no gain.
Related resources for Achilles tendonitis
- Achilles Tendinopathy: Advice and Management
- Achilles Tendonitis
- Common Conditions of the Achilles Tendon
- Current Concepts in Tendinopathy Rehabilitation
- Tendinopathies of the Foot and Ankle
- Tendonitis Treatment and Medications
- Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon
- Victorian Institute of Sports Assessment