In this informative article, “Achilles Tendon Injury Explained: Causes, Symptoms, and Recovery,” we dive into the intricacies of one of the most common foot and ankle injuries. Led by the expertise of board-certified podiatrist Dr. Lauren Dabakaroff, LMD Podiatry offers comprehensive care for a wide range of foot conditions. With a focus on advanced diagnostics and personalized treatment options, we strive to prioritize your foot health. Whether you are dealing with Achilles Tendonitis, bunions, or other issues, we provide surgical and non-surgical solutions, ensuring that you receive the highest standard of care.

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Overuse or repetitive strain

Overuse or repetitive strain is one of the main causes of Achilles tendon injury. This occurs when the tendon is subjected to repetitive stress over a prolonged period of time, leading to microtrauma and inflammation. Activities that involve repetitive motions, such as running and jumping, can put excessive strain on the Achilles tendon and increase the risk of injury.

Direct trauma

Direct trauma to the Achilles tendon can also cause injury. This can occur due to a sudden impact or forceful blow to the back of the heel, such as in sports-related accidents or falls. The impact can cause the tendon to tear or rupture, resulting in severe pain and disability.

Poor footwear

Wearing poor or ill-fitting footwear can contribute to the development of Achilles tendon injury. Shoes that do not provide proper support or cushioning can increase the strain on the tendon and cause it to become inflamed. High heels and shoes with a rigid sole can also put additional stress on the Achilles tendon and increase the risk of injury.

Tight calf muscles

Tight calf muscles can negatively affect the function of the Achilles tendon and increase the likelihood of injury. When the calf muscles are tight, they can transmit excessive force to the Achilles tendon, making it more susceptible to damage. This is particularly common in individuals who do not stretch or warm up properly before engaging in physical activity.

Aging and degeneration

As we age, the tendons in our body become less flexible and more prone to injury. The Achilles tendon is no exception. With age, the tendon gradually loses its elasticity and ability to absorb and transmit force. This age-related degeneration can make the tendon more susceptible to injury, especially during activities that involve repetitive motions or high impact.

Certain medications

Certain medications can also increase the risk of Achilles tendon injury. Fluoroquinolone antibiotics, such as ciprofloxacin and levofloxacin, have been associated with an increased risk of tendon ruptures. These medications can weaken the structure of the tendon, making it more susceptible to injury. It is important to be aware of the potential side effects of these medications and to discuss any concerns with a healthcare professional.

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Pain and stiffness in the back of the heel or calf

One of the most common symptoms of an Achilles tendon injury is pain and stiffness in the back of the heel or calf. The pain may be dull or sharp and can range from mild to severe. It is typically worse with activity and improves with rest. The stiffness can make it difficult to move the ankle or fully extend the leg.

Swelling or inflammation

Achilles tendon injury can cause swelling or inflammation in the affected area. This is a result of the body’s natural immune response to the injury. The swelling may be mild or pronounced, depending on the severity of the injury. In some cases, the swelling may extend up the leg, making it visibly larger than the unaffected leg.

Difficulty walking or standing on tiptoe

Individuals with an Achilles tendon injury may experience difficulty walking or standing on tiptoe. The pain, stiffness, and weakness in the tendon can make it challenging to bear weight on the affected leg. Standing on tiptoe requires a strong and flexible Achilles tendon, which may be compromised in individuals with an injury.

A popping or snapping sound at the time of injury

In some cases, individuals may hear a popping or snapping sound at the time of the Achilles tendon injury. This can be a sign of a partial or complete tear of the tendon. The sound is often accompanied by immediate pain and disability. It is important to seek medical attention if this occurs, as a tendon rupture may require surgical intervention.

Tenderness or warmth

Achilles tendon injury can cause tenderness and warmth in the area of the affected tendon. The skin may feel tender to the touch, and the area may be warm or red. These symptoms are indicative of inflammation and should be evaluated by a healthcare professional to determine the appropriate treatment.

Limited range of motion

Individuals with an Achilles tendon injury may experience a limited range of motion in the ankle joint. The tightness, pain, and stiffness in the tendon can restrict the ability to flex or extend the ankle fully. This can impact daily activities and physical performance.

Achilles Tendon Injury


Medical history and physical examination

To diagnose an Achilles tendon injury, a healthcare professional will typically begin by taking a detailed medical history and performing a physical examination. They will inquire about the onset and nature of symptoms, as well as any previous injuries or medical conditions. During the physical examination, the healthcare professional may palpate the Achilles tendon, assess range of motion, and look for signs of swelling or inflammation.

Imaging tests (ultrasound, MRI)

Imaging tests, such as ultrasound or magnetic resonance imaging (MRI), may be ordered to further evaluate the extent of the Achilles tendon injury. These tests can provide detailed images of the tendon and surrounding structures, helping to identify any tears, ruptures, or degenerative changes. They are particularly useful for assessing the severity of the injury and determining the most appropriate treatment approach.

X-rays to rule out bone fractures or other conditions

In some cases, X-rays may be recommended to rule out other conditions, such as bone fractures or calcification of the tendon. While X-rays do not provide a detailed view of the tendon itself, they can help identify any bone abnormalities or joint issues that may be contributing to the symptoms.


RICE therapy (rest, ice, compression, elevation)

Rest, ice, compression, and elevation (RICE) therapy is often recommended as an initial treatment approach for Achilles tendon injury. Resting the affected leg and avoiding activities that worsen the symptoms can help promote healing. Ice packs or cold compresses can help reduce pain, swelling, and inflammation. Compression with a bandage or brace and elevation of the leg can also aid in controlling swelling.

Physical therapy and stretching exercises

Physical therapy is a key component of the treatment plan for Achilles tendon injury. A physical therapist can design a personalized exercise program to strengthen the tendon, improve flexibility, and restore normal function. Stretching exercises are particularly important in preventing further injury and promoting healing. These exercises help lengthen the tendon and increase its ability to absorb and transmit force.

Orthotic devices (heel lifts, splints, braces)

Orthotic devices, such as heel lifts, splints, or braces, may be recommended to provide support and reduce stress on the Achilles tendon. Heel lifts can help elevate the heel and alleviate strain on the tendon. Splints or braces can provide stability and immobilization, especially during the initial healing phase. These devices are often used in conjunction with physical therapy and other treatment modalities.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, may be prescribed to relieve pain and reduce inflammation. These medications work by inhibiting the production of prostaglandins, which are responsible for the inflammatory response. It is important to follow the healthcare professional’s instructions and take the medication as prescribed to minimize side effects.

Corticosteroid injections

Corticosteroid injections may be considered for individuals with severe pain and inflammation that does not respond to conservative treatment. These injections deliver a powerful anti-inflammatory medication directly to the site of injury, providing prompt relief. However, corticosteroid injections should be used judiciously and under the guidance of a healthcare professional, as they can have potential side effects and may weaken the tendon if overused.

Extracorporeal shockwave therapy

Extracorporeal shockwave therapy (ESWT) is a non-invasive treatment option that uses high-energy shockwaves to stimulate the healing process in the Achilles tendon. The shockwaves promote blood flow and tissue regeneration, helping to reduce pain, inflammation, and promote healing. ESWT is typically performed on an outpatient basis and may require several sessions to achieve optimal results.

Platelet-rich plasma (PRP) therapy

Platelet-rich plasma (PRP) therapy is a regenerative treatment that involves injecting concentrated platelets from the patient’s own blood into the injured tendon. Platelets contain growth factors that stimulate tissue repair and regeneration. PRP therapy has shown promising results in promoting healing and reducing pain in Achilles tendon injuries. However, further research is needed to fully evaluate its effectiveness and determine the ideal treatment protocol.

Surgery (in severe cases or for chronic Achilles tendinopathy)

Surgery may be considered in severe cases of Achilles tendon injury or when conservative treatments have failed to provide relief. Surgical intervention aims to repair or reconstruct the damaged tendon, promoting optimal healing and restoring normal function. The specific surgical technique will depend on the nature and extent of the injury. In some cases, a minimally invasive procedure, such as percutaneous Achilles tendon repair, may be performed.


Rest and gradual return to activity

Rest is crucial during the initial phase of recovery from an Achilles tendon injury. It allows the tendon to heal and prevents further damage. As symptoms improve, a gradual return to activity can be initiated under the guidance of a healthcare professional. It is important to follow a structured rehabilitation program that incorporates progressive loading and strengthening exercises to rebuild the strength and flexibility of the tendon.

Physical therapy and rehabilitation exercises

Physical therapy and rehabilitation exercises play a vital role in the recovery process following an Achilles tendon injury. A physical therapist will develop a tailored treatment plan that focuses on addressing specific deficits and promoting optimal healing. Rehabilitation exercises may include stretching, strengthening, balance and proprioception training, and functional movements to improve overall function and prevent future injuries.

Monitoring progress and adjusting treatment plan

Throughout the recovery process, it is important to monitor progress and adjust the treatment plan as needed. A healthcare professional will assess the healing and function of the tendon, and make modifications to the treatment approach based on individual progress. Regular follow-up appointments and communication with the healthcare team are essential to ensure a successful recovery.

Use of supportive footwear and orthotic devices

Supportive footwear and orthotic devices can help alleviate stress on the Achilles tendon and provide stability during the recovery phase. It is important to choose shoes that provide proper arch support, cushioning, and a supportive heel counter. Orthotic devices, such as custom-made shoe inserts or heel lifts, can further assist in offloading the tendon and promoting optimal healing.

Preventing future injuries with proper warm-ups and stretching

To prevent future Achilles tendon injuries, it is important to incorporate proper warm-up and stretching routines into your exercise regimen. A thorough warm-up prepares the muscles and tendons for activity, increasing their flexibility and reducing the risk of injury. Stretching exercises, particularly focusing on the calf muscles and Achilles tendon, help maintain optimal flexibility and prevent tightness that can contribute to injury.


Proper warm-up and stretching before physical activity

Proper warm-up and stretching before engaging in physical activity can significantly reduce the risk of Achilles tendon injury. A warm-up routine should include light aerobic activity, such as brisk walking, to increase blood flow to the muscles and tendons. Dynamic stretching exercises, which involve moving parts of the body through a full range of motion, can help prepare the Achilles tendon for the demands of the activity.

Gradual increase in intensity and duration of exercise

To minimize the risk of Achilles tendon injury, it is important to gradually increase the intensity and duration of exercise. Sudden increases in activity levels can put excessive strain on the tendon and increase the likelihood of injury. It is advisable to follow a progressive training program that allows for adequate rest and recovery between workouts.

Wearing appropriate footwear for activity

Wearing appropriate footwear for the specific activity is crucial in preventing Achilles tendon injury. Shoes should provide proper support, cushioning, and stability for the feet and ankles. It is important to choose footwear that is specifically designed for the intended activity, whether it be running, tennis, or any other sport. Shoes that are worn out or lack sufficient support should be replaced to maintain optimal foot and ankle alignment.

Avoiding sudden changes in activity levels

Avoiding sudden changes in activity levels can help prevent Achilles tendon injury. Gradually increasing or decreasing the intensity and duration of activity allows the tendon to adapt and become stronger over time. Abrupt changes in activity levels, such as suddenly increasing mileage or abruptly stopping exercise, can overload the tendon and increase the risk of injury.

Maintaining a healthy body weight

Maintaining a healthy body weight is important in preventing Achilles tendon injury. Excess body weight puts additional stress on the tendons and joints, including the Achilles tendon. Losing weight through a balanced diet and regular exercise can reduce the strain on the tendon and lower the risk of injury. Consulting with a healthcare professional or registered dietitian can provide guidance on achieving and maintaining a healthy weight.

Listening to your body and taking breaks when needed

Listening to your body and taking breaks when needed is essential in preventing Achilles tendon injury. Pushing through pain or discomfort can lead to overuse and contribute to the development of injuries. It is important to recognize the signs of fatigue or excessive strain and allow for adequate rest and recovery. Incorporating rest days into your training schedule and modifying activities as needed can help prevent overuse injuries.

Achilles Tendon Injury


Achilles tendon rupture

One of the potential complications of Achilles tendon injury is a complete rupture of the tendon. A rupture occurs when the tendon tears completely, resulting in a significant loss of function and mobility. Achilles tendon ruptures typically require surgical repair and a longer recovery period compared to other types of Achilles tendon injuries.

Chronic Achilles tendinopathy

Without proper treatment and rehabilitation, Achilles tendon injury can progress to chronic tendinopathy. Chronic tendinopathy refers to a degenerative condition characterized by persistent pain, swelling, and dysfunction of the tendon. It can significantly impact daily activities and athletic performance. Treatment for chronic Achilles tendinopathy may involve a combination of conservative measures, such as physical therapy, orthotic devices, and medication, as well as surgical intervention in severe cases.

Increased risk of future injuries

Once an Achilles tendon injury has occurred, there is an increased risk of future injuries. The structural integrity of the tendon may be compromised, making it more susceptible to reinjury. It is important to continue with proper preventive measures, such as warm-up and stretching routines, wearing appropriate footwear, and gradual progression of activity levels, to reduce the risk of recurrent Achilles tendon injuries.

Reduced mobility and flexibility

Achilles tendon injury can lead to reduced mobility and flexibility in the affected leg. The healing process and scar tissue formation can cause stiffness and limited range of motion in the ankle joint. Physical therapy and rehabilitation exercises are essential in restoring mobility and flexibility, allowing individuals to return to their normal activities and maintain an optimal quality of life.

When to See a Doctor

Severe pain and inability to walk or bear weight

If you experience severe pain in the back of the heel or calf and are unable to walk or bear weight on the affected leg, it is crucial to seek medical attention. These symptoms may indicate a more severe injury, such as a complete tendon rupture, which requires immediate evaluation and treatment.

Visible deformity or swelling

The presence of a visible deformity or pronounced swelling in the area of the Achilles tendon should prompt a visit to a healthcare professional. These signs may suggest a severe injury, such as a complete rupture or significant tear, that requires medical intervention.

Injury accompanied by a sudden pop or snap

If you heard a sudden pop or snap at the time of the injury, it is important to see a healthcare professional as soon as possible. This can be an indication of a partial or complete tear of the Achilles tendon, which often requires surgical repair.

Fever or signs of infection

If you develop a fever or notice signs of infection, such as increased warmth, redness, or discharge from the affected area, it is important to seek medical attention. These symptoms may indicate an infection in the injured tendon, which requires prompt evaluation and treatment.


Achilles tendon injury can cause significant pain, discomfort, and limitations in mobility and function. It can be caused by factors such as overuse, direct trauma, poor footwear, tight calf muscles, aging, certain medications, and more. Recognizing the symptoms and seeking early diagnosis and treatment are crucial in preventing further damage and promoting optimal recovery. Treatment options range from conservative measures, such as RICE therapy, physical therapy, and medication, to more invasive interventions, such as corticosteroid injections and surgery. With appropriate treatment and rehabilitation, most individuals can expect a successful recovery and a return to normal activities. Prevention strategies, including proper warm-up and stretching, gradual progression of activity levels, and wearing appropriate footwear, can help reduce the risk of future Achilles tendon injuries. If you experience severe pain, inability to walk or bear weight, visible deformity or swelling, or have signs of infection, it is important to seek medical attention promptly. A healthcare professional can provide a comprehensive assessment, accurate diagnosis, and individualized treatment plan to facilitate a successful recovery and minimize complications.

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