Do you always feel pain in your Achilles tendon, above the heel after a long walk or run or when you wake up in the morning for no reason?
As a radiographer, I will help you better identify possible causes behind the Achilles tendon pain and what you can do to relieve pain.
Happy reading!😀 and feel free to ask questions in the comments or share your own experience.🙏
Last updated: June, 2025. Written by Juliet Semakula, a diagnostic radiographer.
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▶️Basic understanding of Achilles pain (tendinopathy or tendinitis)
I believe you have had different words used to describe Achilles pain, words like tendinopathy or tendinitis are sometimes used interchangeably to describe Achilles pain.
Is Achilles tendon pain different from tendinopathy?
Achilles pain can be a sign of tendinopathy which is a condition where the tendon becomes inflamed or damaged causing pain, reduced strength, stiffness and swelling.
However, your Achilles tendon can also be painful after an activity such as walking or with no reason and not inflamed.
So, the use of the term tendinitis is discouraged because it implies inflammatory activity or irritation which may or may not be present in the injured tendon or pain for no reason
According to international scientific studies, the clinical terminology of tendinopathy was differentiated as highlighted in the table below (scott,2019)
Retrieved from scott,2019
Most of these tendon pains have the same symptoms but sometimes management is different.
In most serious cases, like a rupture or tear of the Achilles tendon, you need to watch out for warning signs such as:
♦️Difficult walking
♦️Sensation of sharp blow
♦️Sharp pain at night or at rest
♦️A loud snap when you make movement.
The diagnosis of an Achilles tendon problem is most often made by a clinical examination alone.so always see your doctor for a proper diagnosis.
Focus for this article will be on Achilles tendinopathy pain above the heel and loss of function related to mechanical loading or pain with no cause.
B, insertion of the Achilles tendon; and C, the medial and lateral fat pad and bursa. (Silbernagel,2020)The purple area indicates the 1st 2 cm from the insertion of the Achilles tendon,the red zone is the middle region,these are the areas where pain is most.
Tendinopathy is the preferred term for persistent tendon pain and loss of function related to mechanical loading (external force to the tendon leading to stress and strain).
Achilles tendinopathy is a painful overuse injury that is extremely common in athletes, especially those who participate in running and jumping sports.
▶️Having Achilles tendon pain after a particular activity? Causes
Have you ever experienced pain around the Achilles tendon after you have had a long walk especially uphill or on uneven surfaces.
This is usually caused by:
🔵Overuse, prolonged or repeated pressure put on the tendon when walking, running or jumping.
🔵When you have weak, or tight calf muscles can sometimes put pressure on the tendon.
🔵If you have fleet feet or other medical issues with your feet, pain can occur after walking.
Achilles heel pain after sports can be caused by:
🔵Returning to sports after a period of not doing any sports. This can cause Achilles heel pain because of that sudden increase in activity.
🔵Training errors can sometimes cause Achilles tendon pain
Among athletes who developed Achilles tendinopathy or pain, 60% to 80% described a sudden change or increase in training intensity or duration (Silbernagel,2020)
Pain may appear suddenly or within a few hours:
⚫The tendon may feel stiff and sensitive to touch.
⚫Sometimes it squeaks when you move your foot.
⚫You may feel discomfort when you wake up.
This pain is often caused by a simple overload of activity causing stress and strain to the tendon. Sometimes the tendon may become inflamed, slightly swollen, then return to normal with partial or total rest.
▶️Having Achilles tendon pain for no reason
There are some people who complain of Achilles tendon pain without any causes, no activity and report no injury to their feet.
Sometimes pain can also come from another disease or degenerative wear and tear of the tendon even when you have not done anything.
What could be the possible causes of such pain:
⚫Improper footwear: if your shoes do not provide adequate support or cushioning, this can put extra strain on the Achilles tendon causing you pain.
⚫Some people have muscle imbalance, or anatomical abnormality that can cause tight calf muscle or weak foot muscles causing pain around the Achilles tendon.
⚫If you have conditions like diabetes, rheumatoid arthritis, or psoriasis, this can increase the risk of Achilles tendon problems.
⚫Age: sometimes older adults are more prone to Achilles tendinopathy, a condition involving tendon degeneration (wear and tear of the tendon)
⚫Any activities done excessively that place the ankle in dorsiflexion for example uphill running may contribute to the development of pain.
⚫Being overweight and smoking has been known to increase tendon problems.
Silbernagel,2020
The common symptoms of Achilles tendinopathy are pain and reduced function of the foot.
Most people describe pain as a gradual onset that includes stiffness in the morning or after prolonged sitting or pain with activities such as running.
▶️What causes swelling of the Achilles tendon?
Your Achilles tendon may swell due to inflammation. When the tendon is overstretched or damaged, your body reacts by sending blood and cells to repair it.
The tendon may swell because:
⚫The small vessels around the tendon dilate.
⚫Fluids accumulate in the tissues
⚫Repair cells arrive on site.
And all this is a sign that the tendon is protecting itself.
Swelling makes the tendon thicker, sometimes hot and painful to the touch.it becomes stiff and less flexible.
To prevent more swelling, try to rest, elevate and ice or wear compression socks to help reduce swelling.
▶️Can tendon pain go away on its own?
Yes, in many cases, tendon pain, often caused by tendinopathy, can improve or resolve on its own with rest and self-care.
Pain can normally take 2 to 3 weeks, with rest and self-care. However, it’s crucial to seek medical advice if the pain persists or is severe, as it could be a sign of a more serious issue or a more extensive injury
When your doctor does a clinical examination of your tendon, it can help identify other potential causes of pain in this area of the heel,
⚫Retrocalcaneal bursitis
⚫Inflammation of the Kager’s fat pad.
⚫Sever’s disease in children around 8 to 11 years.
⚫Nerve compressions.
⚫Plantar fasciitis.
⚫Posterior ankle impingement
▶️How can you be sure it is not something else?
The only way to confirm whether your pain is indeed due to Achilles tendinopathy is to see your doctor or ask other people who are more specialised in Achilles tendinopathy, if all remedies fail.
Remember many things can be confused with Achilles pain, often it can be worrying but it is often benign.It is often not a sign of a more serious underlying disease in most cases.
Always try to rationalise the situation and avoid cognitive biases that lead us to immediately think of serious conditions such as cancer when faced with less serious symptoms such as pain.
Working in the interventional radiology I have seen so many patients who come for liver biopsy, worried even before the biopsy is taken thinking it might be cancer, yet in most cases it is nothing to worry about.
▶️When should I consult a doctor about a painful Achilles tendon?
In most cases Achilles pain which is not severe normally it goes away after a few weeks but:
🔴If you experience pain, weakness, stiffness, swelling, or reduced movement at the back of your heel preventing you from walking, then it is advisable to get it checked
🔴If you have persistent pain or symptoms despite rest, ice and painkillers, then consult a doctor it could be more than heel pain
🔴If you hear a popping or snapping sound at the time of injury, it can suggest a possible tendon rupture.
In the meanwhile, here are other things you can do to help speed up the disappearance of ankle swelling and pain whatever the original cause.
▶️What can be done to avoid or relieve pain?
🟣Rest: Reduce activity and avoid putting extra strain on the tendon.
🟣 Ice: Apply ice packs to reduce inflammation and pain.
🟣Compression: Use a bandage or athletic tape to help reduce swelling.
🟣 Elevation: Raise your foot to help reduce swelling.
🟣Pain relievers: Over-the-counter pain medications can help.
🟣Walking boot or heel lifts: May be recommended in some cases.
🟣Physical therapy: Exercises to strengthen calf muscles and improve flexibility.
Exercise rehabilitation provides mechanical load to the tendon to promote remodelling, decrease pain, and improve calf-muscle endurance and strength and lower leg function.
Here are exercise illustrations retrieved from Silbernagel et al 2020
Some of the commonly used Achilles tendon-loading exercises. A, Bilateral heel rise. B, Unilateral heel rise. C, Seated heel rise. D, Eccentric heel rise. E, Rebounding heel rise (Silbernagel,2020)
▶️How can you manage your activities and minimise or avoid pain at the same time
⬛Try to identify activities that you would consider severely painful, moderately painful and mildly irritating and act to change your habits.
If you can identify the level of pain you are experiencing, you will find out if you are in the green, amber or red zone. The best way to move down to the green zone is by pacing and spacing your activity.
When you are completing your rehabilitation exercises it is often best to work within the green and sometimes amber zones depending on what you deem is an acceptable level of pain.
Both during the exercises and within 48 hours of completing your exercises. If you find yourself in the red zone you are likely pushing yourself too hard and may flare up the pain.
A video showing activity ladder that can help you identify what you would consider severely, moderately and mildly painful.
video retrieved from: NHS Lanarkshire Musculoskeletal Physiotherapy
When you are completing your rehabilitation exercises it is often best to work within the green and sometimes amber zones depending on what you regard is an acceptable level of pain
⬛Pacing and spacing activity or task: Try to take regular breaks this will help to reduce pressure on the foot.
Try to rest between activities and set achievable goals you can manage.
▶️How long does it take for Achilles tendinopathy pain to go?
Achilles tendinopathy healing time will vary for everyone, and this will be determined by several factors.
Here are factors that will influence your healing:
🟤How severe your injury or pain is.
🟤Individual response to treatment.
🟤Treatment and rehabilitation plan you were given by your doctor.
🟤Activity level
🟤Tendon structure changes if you had surgery.
It would be unfair to tell you that in your individual case pain will last this long without knowing your condition.
However, most people I have seen usually see their symptoms improve within 3 to 6 months. However, full recovery can take up to a year in some cases especially with more chronic or severe injuries.
It is also normal to have periods of increased pain or flare ups during your recovery.
| THE BOTTOM LINE |
| Achilles tendinopathy is a clinical diagnosis based on localized tendon pain and swelling and pain with activities. |
| Exercise that provides mechanical loading of the Achilles tendon is the treatment with the highest level of evidence. |
| Treatment should focus on activity modification and progressive tendon-loading exercises. |
| Full recovery of symptoms does not ensure full recovery of function or tendon structure. |
| · The best prevention is to recognize early “minor” symptoms and treat with load control. |
We have come to the end of this article, wish you a quick recovery! 🙋
Any questions or experience in the comment section below.
📚Sources:
Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020 May;55(5):438-447. doi: 10.4085/1062-6050-356-19. Epub 2020 Apr 8. PMID: 32267723; PMCID: PMC7249277.
Scott A, Squier K, Alfredson H, Bahr R, Cook JL, Coombes B, de Vos RJ, Fu SN, Grimaldi A, Lewis JS, Maffulli N, Magnusson SP, Malliaras P, Mc Auliffe S, Oei EHG, Purdam CR, Rees JD, Rio EK, Gravare Silbernagel K, Speed C, Weir A, Wolf JM, Akker-Scheek IVD, Vicenzino BT, Zwerver J. ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology. Br J Sports Med. 2020 Mar;54(5):260-262. doi: 10.1136/bjsports-2019-100885. Epub 2019 Aug 9. PMID: 31399426.
Magnussen RA, Dunn WR, Thomson AB. Nonoperative treatment of midportion Achilles tendinopathy: a systematic review. Clin J Sport Med. 2009 Jan;19(1):54-64. doi: 10.1097/JSM.0b013e31818ef090. PMID: 19124985.
Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80(2):188-201. PMID: 1897886.