Getthebackofyourheelbacktonormal.

• Achilles tendonitis is inflammation or degeneration of the tendon that runs from your calf to your heel.
• It typically shows up as pain and stiffness in the back of the heel, especially with the first steps of the day and after exercise.
• Most cases respond to a graduated program of rest, eccentric calf strengthening, footwear changes, and physical therapy.
• Stubborn or chronic cases benefit from physical therapy with eccentric loading protocols; surgery is reserved for severe degenerative cases.
• Continuing to run through Achilles pain risks a partial or complete rupture — get it evaluated rather than ignoring it.

What is Achilles tendonitis?

Achilles tendonitis is irritation of the Achilles tendon — the thick cord at the back of your ankle that connects your calf muscles to your heel bone. In acute cases the tendon is inflamed; in chronic cases (more accurately called "tendinopathy" or "tendinosis") the tendon has actually started to break down at the fiber level and is no longer healing properly on its own.

It is one of the most common overuse injuries we see in runners — especially those increasing mileage too fast or pushing pace on hills. It also shows up in weekend athletes returning to sport after a layoff, and in middle-aged adults whose tendon quality has changed with age. Tight calves, sudden changes in shoes (going from a high heel-drop to a minimal shoe), and harder running surfaces all contribute.

At Northwest Extremity Specialists, our sports medicine and general podiatry teams use a graduated, conservative-first protocol — and the vast majority of cases resolve without surgery. For chronic tendinopathy that hasn't responded to physical therapy alone, we coordinate with our in-house PT team on advanced eccentric-loading protocols and consider surgical options only when conservative care has been thoroughly exhausted.

See it in motion

The Achilles tendon is the largest and strongest tendon in the human body. It connects the gastrocnemius and soleus muscles of the calf to the back of the heel bone (calcaneus). When you push off in walking, running, or jumping, the Achilles transmits the force from your calf muscles down into your foot. It tolerates enormous loads — but it has a relatively poor blood supply in its middle portion, which is why it heals slowly and is prone to overuse injury.

What it feels like

Achilles tendonitis has a recognizable pain pattern centered at the back of the heel:

• Pain and stiffness in the back of the heel, worst with the first steps of the day
• Aching in the tendon during or after running or other activity
• A thickened, sore spot you can feel along the tendon itself, usually 2–6 cm above the heel
• Pain when squeezing the sides of the tendon
• Stiffness that loosens up after a few minutes of walking, then returns the next morning
• Visible swelling or a soft lump along the tendon in more chronic cases
• Crepitus (a creaking sensation) when moving the ankle in advanced cases

Why it develops

Achilles tendonitis is almost always an overuse problem, driven by some combination of these factors:

• Sudden increase in running mileage, pace, or hill work
• Tight calf muscles that overload the tendon with every step
• Switching to lower-drop or minimalist shoes too quickly
• Worn-out athletic shoes that have lost support
• Sport on hard surfaces (track, road, gym floor)
• Returning to sport after a long layoff without building back up
• Age-related tendon degeneration (more common after 40)

How we diagnose Achilles tendonitis

A first visit for Achilles pain is mostly clinical. Your provider will examine the back of the heel and ankle, palpate the tendon to find the exact tender area, test calf strength, and assess flexibility. On-site digital X-ray may be used to rule out a heel-bone problem or to look for calcification within the tendon. Ultrasound or MRI is reserved for cases where we suspect a partial tear or are planning advanced intervention. Most patients leave the same day with a clear diagnosis.

Non-surgical care

Conservative treatment works for the vast majority of Achilles tendonitis cases. The cornerstone is a guided eccentric strengthening program, which has the strongest evidence base of any treatment for this condition:

• Daily eccentric calf strengthening (heel-drop exercises) — typically the single most effective intervention
• Calf stretching program targeting both the gastrocnemius and soleus
• Temporary heel lifts to reduce tendon load
• Activity modification: reduce mileage, swap pavement for softer surfaces, avoid hills temporarily
• Supportive athletic shoes with appropriate heel-to-toe drop
• Physical therapy referral for guided progression
• A short course of anti-inflammatories for acute flare-ups (with caution — long-term NSAID use can impair tendon healing)

Surgical care

Surgery for Achilles tendonitis is uncommon and is reserved for severe degenerative tendinopathy, partial tears that aren't healing, or cases with a bony spur (Haglund's deformity) at the back of the heel that's irritating the tendon.

• Debridement of degenerated tendon tissue
• Removal of a Haglund's deformity or retrocalcaneal spur
• Repair of partial or complete tendon tears
• Tendon transfer or augmentation in severe degenerative cases

Most Achilles surgeries involve a period of immobilization in a boot or cast for 4–6 weeks, gradual return to weight-bearing, then a structured PT program. Return to running typically takes 4–6 months; return to high-level sport is often longer.

When to see a specialist

• Achilles pain that hasn't improved after a week of rest and ice
• A sudden "pop" or sharp pain in the back of the heel during activity — this could be a partial or complete rupture and needs urgent evaluation
• Visible swelling, lump, or thickening of the tendon
• Pain severe enough to alter your gait
• Symptoms that keep coming back as soon as you return to running

Our sports medicine team — including Dr. Todd Galle in Wilsonville and Dr. Manny Moy in Cedar Mill — treats a high volume of Achilles tendonitis, with extensive experience guiding patients through chronic-tendinopathy rehab. Any of our board-certified podiatrists can evaluate and treat Achilles pain at any of our 8 Portland-area locations.

Frequently asked questions

• Plantar Fasciitis
  Often coexists — same calf-tightness pattern drives both
• Heel Spurs
  Retrocalcaneal spurs can irritate the Achilles
• Stress Fractures
  A calcaneal stress fracture can mimic Achilles pain — important to rule out
• Tendonitis
  Other foot tendons (posterior tibial, peroneal) follow similar patterns