Achilles tendonitis, more accurately tendinopathy, is overuse irritation and wear of the Achilles tendon, the heel cord that connects the calf to the heel. It comes in two main forms, midportion (a few centimeters above the heel) and insertional (right at the heel bone), which are treated somewhat differently.
It is common in runners and in people who increase activity quickly. Despite the name 'itis,' it is largely degeneration rather than active inflammation, which is why a structured loading program, not rest alone, is the foundation of treatment.
Symptoms
Typical complaints include:
- Pain and stiffness in the heel cord, worse in the morning and at the start of activity
- Tenderness and sometimes thickening of the tendon
- Pain with running, jumping, and climbing stairs
- A creaking sensation in the tendon in some cases
How it is diagnosed
Achilles tendonitis is largely a clinical diagnosis based on tenderness and pain with loading the tendon. Ultrasound or MRI is used to assess the tendon when the picture is unclear, recovery stalls, or there is concern about a partial tear.
Dr. Lee treats Achilles tendonitis patiently and conservatively, with a structured loading program, especially eccentric and heavy-slow calf exercise, the approach with the best track record for this tendon, along with load management and footwear or heel-lift adjustments.
For tendons that stall, PRP is an option Dr. Lee discusses. Surgery is reserved for the small minority with persistent pain after an extended program. One caution shapes everything: a tendon weakened by chronic tendinopathy is at some risk of rupture, so loading is progressed sensibly and steroid injection into the tendon is avoided.
Non-surgical treatment
The foundation is loading the tendon, not resting it:
- A structured eccentric and heavy-slow calf-loading program
- Load and training-volume management
- A heel lift or footwear adjustment, particularly for the insertional form
- PRP as an option for tendons that are not healing
When conservative care stalls
Surgery, which addresses the degenerated portion of the tendon and any bone spur in the insertional form, is reserved for the small minority whose pain persists after an extended, genuine loading program. Steroid injection into the tendon is avoided because it can weaken it.
Recovery timeline
Recovery is measured in months and depends on consistent loading:
- Weeks 0 to 12A structured calf-loading program with load management. Improvement is gradual.
- Months 3 to 6Progressive return to running and sport as the tendon tolerates load.
- After surgery (rare)Protected loading early, then a graded program over several months.
What patients commonly misunderstand
Two things to get right:
- Rest alone usually is not enough. Because Achilles tendonitis is mostly degeneration, the tendon needs progressive loading to heal. Complete rest helps briefly, then the pain returns with activity.
- Avoid steroid injections into the tendon. Injecting steroid directly into the Achilles can weaken it and raise the risk of rupture, so it is avoided. The loading program is the safer, more effective foundation.
This page is general educational content authored by Dr. Lee. It is not a substitute for individual medical advice. Every patient's case is different, book a consultation to discuss yours.