Chronic Ankle Pain? 6 Signs You May Have Achilles Tendonitis

The Achilles tendon connects your calf muscle to your heel bone and is prone to overuse injuries, especially in runners and those in middle age. It’s a tendon that’s built for stressful use, but overuse frequently results in a condition called tendonitis.

If you’re in the Chicago area and think you may be suffering from Achilles tendonitis, Dr. Lisa M. Schoene and her colleague Dr. Bruce Bever may be able to help. In this article, we explore what Achilles tendonitis is and some of the most common signs to look out for.

What Is Achilles Tendonitis?

Photo by Kindel Media:

The Achilles tendon is the strongest and largest tendon in the body. To support the body’s weight throughout the range of motions required in walking, running, and jumping, this well-developed tendon is often overused. There are two different types of Achilles tendonitis.

  • Insertional Achilles tendonitis is found on the lower portion of the tendon near the heel bone. This type of tendonitis is not exclusive to those who are physically active and can happen to people of any age. However, it is commonly found in long-distance runners or athletic patients.
  • Non-insertional Achilles tendonitis involves the middle portion of your tendon experiencing small tears and swelling, which is frequently found in active adults.

Causes of Achilles Tendonitis

It’s very easy to overuse your Achilles tendon if you do any form of physical activity, especially athletic activities. A sudden increase in repetitive activity is a common trigger of the condition. Suddenly changing stress levels on the tendon can lead to ruptures and tears of the tendon fibers. The body naturally repairs these fibers when under normal stress, but when the stress is ongoing, it can prevent the body from performing its normal repair of the injured tissues. This creates chronic pain.

The most common causes are:

  • Repetitive up and down flexing at the ankle from participation in sports activities or by those who do manual labor requiring repetitive motions.
  • Extra stress on the heel and Achilles tendon during walking. This is commonly found in those with excessive pronation of the foot arch (flattening) who don’t use proper foot support or who switch to a flatter heeled shoe (zero drop type running shoe) or unsupportive shoe.
  • Tight calf muscles. Without proper stretching, these muscles can place increased stress on the Achilles tendon and make it prone to tears.
  • A much less common cause is Haglund’s deformity. Sufferers have an enlarged heel bone (bone spur), which can cause repetitive wear on the Achilles tendon.

Risk Factors

Several risk factors can make one prone to Achilles tendonitis. These risk factors are:

  • Age: Your risk increases as you get older.
  • Sex: It’s most commonly found among men, very likely as a result of the type of sports they participate in.
  • Physical issues: Flat feet, obesity, and tight calf muscles contribute considerably.
  • Training: Wearing flat, unsupportive, or tight shoes and exercising on uneven terrain or during cold weather can contribute to injury.
  • Medical issues: arthritic issues, Chron’s disease, and some antibiotic medications can increase your risk of Achilles tendon injuries.

What Are the 5 Signs of Achilles Tendonitis?

There are five common signs of Achilles tendonitis, pain being the most common. The symptoms include:

  • Pain when the Achilles tendon moves or is touched.
  • Warmth and inflammation near the heel or the Achilles tendon.
  • Achilles tendon pain and stiffness after rest.
  • Heel pain paired with Achilles tendon pain when performing normal walking or running.
  • Difficulty in standing on the ball of the foot or toes.


Pain is very common with this condition. It may appear as aching, stiffness, tenderness, or soreness anywhere near the tendon itself. It can begin near the calf muscle and go all the way down to the heel. This pain is often first noticed in the morning or after long periods of rest. The pain does improve slightly with use but can worsen with increased activity.


Tenderness is noticed whenever the tendon is squeezed from the sides. It’s not noticed as much if pressed from the back of the tendon.


The tendon can degenerate and become enlarged with nodules surrounding the damaged tissue. It’s important to address this injury before it reaches the degeneration point.

Diagnosis of Achilles Tendonitis

Numerous diagnostic tests can be performed to clarify if the issue is the Achilles tendon or something else. X-rays can be performed to look for any bone deformities or injuries. Magnetic Resonance Imaging can be done if the injury isn’t healing properly to determine if surgery is necessary. The most commonly used test is ultrasound, which is our favorite test as it can examine the tendon while in motion which an MRI can not do. Your doctor will also review your symptoms and will examine the tendon, performing range of motion testing and strength testing on the injured area to check for pain and swelling.

Treatment of Achilles Tendonitis

Unfortunately, there’s no quick fix for Achilles tendonitis. It will likely take many months to recover and require substantial rest for the tissue to repair itself. Pain management can be done through various types of anti-inflammatory medication. You’ll also be asked to modify your shoe choice and activity levels and participate in physical therapy exercises to rehabilitate the injured tissue. You can also ice the area for up to 20 minutes at a time to help bring down swelling and reduce pain.

Even in extreme cases, we do not do any cortisone injections at our office as we have numerous natural medicines that we can inject and use topically. Sometimes we’ll also incorporate physical therapy, massage therapy, stretching, shoe changes or the use of a walking boot, night splinting, or extracorporeal shockwave therapy. In rare cases, surgery may be necessary, which would involve repairing or lengthening the tendon, or removal of a bone spur or prominence in the back of the heel. Conservative therapy, when aggressive, can give us great long-term outcomes. Surgery may require 6-12 months of physical therapy to rehabilitate the injured area. There’s a 20-30% chance of long-term pain for some patients.

Schedule an Appointment

If you feel you may have Achilles tendonitis, please take a moment to schedule an appointment today with Dr. Bever or Dr. Schoene. Dr. Schoene has worked with many athletes in her time and was a part of the USA medical team in the 1996 Olympics. You can schedule your appointment by giving us a call today or by contacting us through our website.