Causes of Achilles tendonitis

achilles tendinopathy

Comparison between normal anatomy and Achilles tendinitis.

Overuse of the tendon is the most common direct cause. In other words, you may have walked or ran too much in a given amount of time. This results in pain, inflammation and damage to the tendon.

The term “Achilles tendinopathy” is now used rather than “tendonitis” or “tendinitis” as the tendon’s structure changes as well as becoming inflamed.

Certain factors can increase the risk of Achilles tendinopathy:

  • weight gain or being overweight
  • High arches or flat feet
  • having calf muscles that are too shortReferred to as retraction of the gastrocnemius muscles..
  • A Haglund’s deformity
  • unsuitable or overly-worn shoes
  • certain medicationsIn particular fluoroquinolones and statins.


Finally, it is essential to point out that the Achilles tendon loses its elasticity with age. As a result, people in older age groups are more prone to developing this condition.



Symptoms of Achilles tendinopathy


The main symptom is pain at the back of the heel along the Achilles tendon which begins and worsens gradually.

A “cold start”, like when getting out of bed, can be very painful. The pain typically worsens with activity throughout the day and gets better with rest.

The Achilles tendon can also thicken as time goes on. A lump may then form on the tendon which can be clearly seen above the heel.


Additional exams


No additional exams are required to diagnose Achilles tendinopathy which is done by examining the calf and foot during your consultation.

However, the below exams are able to confirm the severity of the condition as well as the presence of certain risk factors:

  • X-ray (to screen for a Haglund’s deformity which would require your treatment to be modified)
  • Ultrasound
  • MRI



Treatment of Achilles tendinopathy

Treatment measures for Achilles tendinopathy aim to relieve the pain by reducing the tension on the tendon and the associated inflammation. It is essential to follow these measures until the pain completely disappears in order to ensure a successful recovery. The older the symptoms are, the longer this will take. For this reason, treatment may take several months.

The treatment measures recommended by Dr Metmer are:

  • RestingYou should limit your travel and avoid prolonged walking and stamping your foot the foot
  • Wearing insolesCustom-made by a podiatrist, insoles support the arch of the foot and have heel cups which reduce the amount of tension on the tendon.
  • Platelet-rich plasma (PRP) therapy. More information here
  • Physiotherapy
  • Applying an ice pack to the heel
  • Anti-inflammatoriesFor occasional use during particularly painful periods.
  • Avoiding unsuitableYou will need an insole with heel and arch support and flat shoes should be avoided. footwear
  • Treatment of risk factors (more information below)

Risk factors

Risk factors for Achilles tendinopathy should also be addressed:

  • if you are overweight, losing weight may help.
  • if you have high arches or flat feet, you should always wear insoles.
  • a Haglund’s deformity should be treated.
  • if your calf muscles are too short, they should be stretched.
  • if you take certain medications such as fluoroquinolones and statins, your prescription will be discussed and a substitution may be suggested.



  • How does this condition progress? If this condition is not treated, the pain has a tendency to worsen. The intensity of the pain will increase and the distance you are able to walk without being in pain will decrease. The tendon can even tear in the most severe cases.
  • Which sports and activities am I allowed to do? Swimming (without flippers). Cycling and walking should be avoided.
  • When can I go back to playing sports? As soon as you have completed your recovery, i.e., when no pain is felt at any point in the day. Every case is different, therefore it is not possible to provide an exact time frame for this.