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Achilles tendonitis and achilles tendinopathy

What is achilles tendonitis and achilles tendinopathy?

The achilles tendon connects the calf muscle to the heel. Tendinopathy occurs due to wear and tear or overuse of the tendon. This causes significant pain in the back of the heel.

How does achilles tendinopathy occur?

Achilles tendinopathy occurs due to injury to the achilles tendon. This can be an acute injury or a chronic overuse injury.

There are many risk factors that can lead to achilles tendinopathy.

  • Tight calf muscles

  • Tight achilles tendon

  • Hill running

  • Poor footwear

  • Sudden increase in training

  • Flat feet

  • Obesity

  • Fluoroquinolone antibiotics

Achilles tendinopathy symptoms

Achilles tendinopathy causes pain and swelling over the achilles tendon. This can be in the middle of the tendon or at the insertion on to the heel bone. The tendon will be very tender. It may hurt to walk or put weight on the foot. This can limit ankle range of motion. Severe cases may result in enlargement of the heel bone.

Diagnosis of achilles tendinopathy

Diagnostic ultrasound is the fastest and easiest way to diagnose achilles tendinopathy.

Findings include:

  • Thickening of the tendon

  • Tendon fibers will appear darker than normal

  • Abnormal presence of blood vessels in the tendon

  • Bone spurs at the insertion of the tendon on the heel

The presence of blood vessels, called neovascularization, correlates with worse severity.

The above ultrasound image shows severe achilles tendinopathy.

  • The orange arrow shows the thickness of the achilles tendon. This is much thicker than a normal achilles tendon.

  • The blue arrow section is normal tendon. The fibers here are nice and bright.

  • The red arrow section is tendinosis. The fibers here are much darker.

Achilles tendinopathy treatment

The achilles tendon heals slow, usually over the course of months. This is because the achilles tendon has poor blood supply. Most cases do well with conservative treatment.

Activity and shoes

  • Modify activity and avoid repetitive movements that cause pain.

  • Orthotic inserts can help address flat feet and provide more arch support.

  • Heel pads and heel lifts can help provide support to the achilles tendon.

  • Severe cases may need a walking boot for immobilization.



  • A home exercise program or physical therapy can help rehabilitate the achilles tendon.


  • This study showed that ultrasound guided high volume injections and platelet rich plasma injections can be effective in reducing pain and improving activity level. Follow up diagnostic scans show reduced tendon thickness and decreased vascularity.

  • This case series found that ultrasound guided percutaneous tenotomy helped reduce pain and improved quality of life.

Persistent pain despite conservative measures may require surgery.

Exercises for achilles tendinopathy


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