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Pain on the backside of your heel could be a sign that you have Achilles tendinitis, or inflammation of the Achilles tendon. Overuse could be a cause, and treatments range from home remedies to surgery.
Achilles tendinitis is when there’s irritation and inflammation in the Achilles tendon, a large tendon that attaches your calf muscles to your heel bone, or calcaneus.
You use the Achilles tendon to jump, walk, run, and stand on the balls of your feet. Overusing or damaging this area can lead to Achilles tendinitis.
There are two types of Achilles tendinitis:
- Noninsertional Achilles tendinitis involves small tears in the fibers of the middle portion of your tendon and tends to affect younger adults who are active.
- Insertional Achilles tendinitis affects the lower portion of your tendon where it attaches to your heel bone. It can affect people of any age, including individuals who aren’t physically active.
Simple home treatments can help relieve pain and heal Achilles tendinitis.
However, if home treatment doesn’t work, it’s important to contact a healthcare professional. If Achilles tendinitis gets worse, your tendon can rupture, or burst. You may need medication or surgery to treat the condition.
The main symptom of Achilles tendinitis is pain and swelling in the backside of your heel when you walk or run. You may also have tight calf muscles and limited range of motion when you flex your foot.
Common symptoms of Achilles tendinitis also include:
- pain in your heel or behind your calf when you touch or move it
- pain or swelling in that area that worsens when you’re walking or running, or the day after you exercise
- discomfort or swelling in the back of your heel
- limited range of motion when flexing your foot
- stiffness and soreness in the Achilles tendon when you wake up
- warmth around the heel or along the tendon
- difficulty standing on your toes
- thickening of the Achilles tendon
Achilles tendinitis is often caused by overusing the tendon during exercise or from gradual wear and tear as you age. It can also be caused by arthritis, especially among middle-aged and older adults.
Other common causes of Achilles tendinitis include:
- exercising without warming up first
- straining the calf muscles during repeated movements
- playing sports, such as tennis, that require quick stops and changes of direction
- running too far, too intensely, or uphill too often
- sudden increase in physical activity without allowing your body to adjust
- wearing old or poorly fitting shoes
- wearing high heels daily or for long periods of time
Many treatments are available for Achilles tendinitis, ranging from home remedies like rest and anti-inflammatory medication to more invasive treatments like steroid injections, platelet-rich plasma (PRP) injections, and surgery.
Here are some other common treatments for Achilles tendinitis:
- reducing your physical activity
- switching to low-impact exercises, such as swimming
- very gently stretching and later strengthening your calf muscles
- icing the area after exercise or when in pain
- elevating your foot to decrease any swelling
- wearing a brace or walking boot to prevent heel movement
- going to physical therapy
- taking anti-inflammatory medication, such as aspirin (Bufferin) or ibuprofen (Advil), for pain relief
- wearing a shoe with a built-up heel to take tension off your Achilles tendon
The rest, ice, compression, and elevation (RICE) method can be effective in treating Achilles tendinitis right after you’re injured. Here’s how it works:
- Rest. Don’t put pressure or weight on your tendon for 1 to 2 days until you can walk without pain. The tendon usually heals faster if no additional strain is placed on it during this time. Your doctor may suggest that you use crutches if you need to get around while resting your tendon.
- Ice. Put ice in a bag, wrap the bag in cloth, and place it against your skin. Hold the bag on your tendon for up to 20 minutes, then take the bag off to let the tendon warm up again. The ice usually makes inflammation or swelling go down faster.
- Compression. Wrap a bandage or athletic tape around your tendon to compress the injury. You can also tie an article of clothing around this area. This helps prevent additional swelling. Make sure not to wrap or tie anything too tightly around your tendon, as it can limit blood flow.
- Elevation. Elevate your foot above the level of your chest. Because your foot is higher than your heart, blood returns to the heart and keeps the swelling down. This is easiest to do by lying down and putting your foot on a pillow or other raised surface.
If home treatments don’t work, surgery may be necessary to repair your Achilles tendon. If the condition worsens and is left untreated, there’s a greater risk of an Achilles rupture, which requires emergency medical attention. This can cause sharp pain in the heel area.
Your doctor may recommend a few options for Achilles tendon surgery based on how severe the condition is and where it’s located. Surgery may involve:
- lengthening your calf muscles (gastrocnemius recession)
- removing bone spurs (growths of extra bone), damaged tendon tissue, or both
- repairing the tendon
- strengthening the area by moving another tendon to the heel bone
Your doctor will usually refer you to an orthopedic surgeon to decide which procedure is best for you. If you don’t already have an orthopedist, our Healthline FindCare tool can help you connect to physicians in your area.
To diagnose Achilles tendinitis, your doctor will ask about your symptoms, overall health, and medical history.
They will also do a physical exam of your Achilles tendon, which may include checking for bone spurs and swelling. The doctor may feel around the area to pinpoint where the pain and swelling are most severe.
You may also need to stand on the balls of your feet so your doctor can check your range of motion and flexibility.
In some cases, a doctor may order imaging tests to confirm whether you have Achilles tendinitis. This may include:
- X-rays, which provide images of foot and leg bones
- MRI scans, which can detect ruptures and tissue degeneration
- ultrasounds, which can show tendon movement, related damage, and inflammation
Achilles tendinitis can happen to anyone. However, you may be at higher risk if you:
- try a new sport
- begin exercising more frequently or more intensely
- work out on an uneven surface
- wear inappropriate shoes while exercising
- have bone spurs on your heel
- have tight or weak calf muscles
- take fluoroquinolone, a class of antibiotics
- have diabetes
- have a body weight that’s higher than typical
In general, Achilles tendinitis is more common among men and people age 30 and up.
The most common complication of Achilles tendinitis is pain, which may take at least 2 to 3 months to go away completely. You may also have trouble walking or exercising, and your tendon or heel bone could become deformed.
People with Achilles tendinitis also face a small risk of rupture. This happens when the tears in your tendon fibers worsen and cause a complete or partial break in the Achilles tendon.
Hearing a “pop” from the back of your heel or calf is a sign of a rupture. This is a serious emergency that may require surgery to fix.
A 2017 study found that complications such as infection or difficulties in wound healing are possible, though uncommon, after a surgery for Achilles tendinitis.
Complications can worsen if you don’t follow your doctor’s instructions after an operation. If you continue to put stress on your Achilles tendon after surgery, your tendon can rupture again.
To lower your risk of Achilles tendinitis, try to:
- Stretch your calf muscles at the beginning of each day to improve your agility and make your Achilles tendon less prone to injury.
- Warm up your muscles before working out or playing sports. To stretch your Achilles tendon, stand with a straight leg and lean forward as you keep your heel on the ground.
- Ease into a new exercise routine, gradually intensifying your physical activity. Avoid putting too much pressure on your body too quickly.
- Combine high- and low-impact exercises, such as basketball with swimming, to reduce constant stress on your tendons.
- Wear shoes with proper cushioning and arch support. Make sure the heel is slightly elevated to take tension off your Achilles tendon. If you’ve worn a pair of shoes for a long time, consider replacing them or using arch supports.
- Reduce the heel size of shoes gradually when transitioning from high heels to flats. This allows your tendon to slowly stretch and increase its range of motion.
- Exercise on flat, even surfaces.
- Be extra careful exercising if you’re taking fluoroquinolone.
- Stop doing activities that cause pain.
Acute symptoms of Achilles tendinitis usually go away after a few days of rest and proper home treatment, including the RICE method.
However, some pain may linger for months. Full recovery could take a lot longer if you continue to put pressure on the tendon or don’t change your exercise habits to prevent another injury or rupture.
Long-term tendinitis can cause additional problems, such as tendonosis, or weakening of the tendon.
A tendon rupture or chronic Achilles tendinitis may require long-term treatment or surgery. Full recovery from surgery can take anywhere from a few weeks to a few months.
Seeking treatment for Achilles tendinitis or a ruptured tendon right away is very important. Carefully following your doctor’s instructions will give you a much better chance for a quick recovery.