As an avid hiker and backpacker, I periodically suffer from Achilles Tendonitis ankle pain. Actually, I am currently struggling with Achilles Tendonitis pain right now. My latest onset was caused by a sudden change in activity level that caused an increased load or stress through my Achilles tendon.
See, during the wintertime, my wife and I typically participate in backcountry skiing, which does not load the calf muscles and Achilles tendon heavily. Then, a couple of weeks ago, we decided to attempt a summit climb up Mount Hood (a local cascades volcano). Climbing up a steep incline for several hours places A LOT of stress through the Achilles tendon. This sudden increase in tendon stress caused irritation and inflammation in my Achilles tendon leading to my current episode of Achilles Tendonitis pain.
Luckily, there are some key physical therapy Achilles Tendonitis exercises that I have been doing that have been doing since that have already been helping relieve my ankle pain.
- Convenient Access: Print or Use On-the-Go on Any Mobile Device
- Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
- Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
- Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
- Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Convenient Access: Print or Use On-the-Go on Any Mobile Device
Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Table of Contents
What is the Achilles Tendon?
The Achilles tendon is the largest tendon in the body. It connects the calf muscles to the heel bone (calcaneus). When the calf muscles contract, the tendon shortens elevating the heel bone and simultaneously presses the forefoot downward.
Since it is such a large tendon, it can withstand immense forces. Studies have shown that the Achilles tendon is capable of handling forces greater than 1000 lbs. That’s a lot of force!
However, repetitive exposure to stresses like those that the tendon experiences during walking, running, jumping, stair climbing, and raising up on the toes can lead to overuse inflammation and degeneration within the tendon. This type of foot and ankle injury is known as Achilles Tendonitis, also spelled as “Achilles Tendinitis”.
Achilles Tendonitis Symptoms
Symptoms that are typically found with Achilles Tendonitis include:
Dull, aching sensation along the Achilles tendon after increased activity (walking, stair climbing, kneeling, etc.)
Sharp, stabbing-type pain in the tendon during higher-level activities (running, jumping)
Tenderness to the touch along the Achilles tendon
Tightness in the calf muscles
Swelling around the tendon
Stiffness of the tendon, especially in the morning or after sedentary for long periods of time
Thickening of the tendon in advanced stages of the condition (longer than 2-3 months)
Causes of Achilles Tendonitis
Achilles Tendonitis is an overuse injury that can also lead to tendon degeneration in chronic stages. Activities that place increased demand and stress through the Achilles tendon cause inflammation and irritation of the tendon whenever the tendon does not have to total capacity to perform the amount of work that is being placed upon it.
Typically someone performs an activity that he/she is not used to performing. Just like the example that I gave in my introduction paragraph. I climbed a steep incline up a volcano without conditioning my Achilles tendon and calf muscles after an entire winter season off.
I’ve treated patients who have spent several hours and days in a kneeling position while building a deck develop Achilles Tendonitis.
I’ve also had patients who were trying to lose weight by walking hills in the local neighborhood cause Achilles Tendonitis.
Other causes of this condition include:
Tight calf muscles (not stretching enough)
Tight plantar fascia (bottom of the foot), which can lead to Plantar Fasciitis pain
Flat feet
Bone spurs present (extra bone growth where the tendon inserts into heel bone)
Wearing high heels or cowboy boots frequently (leads to tight calf muscles)
Types of Achilles Tendonitis
Insertional Achilles Tendonitis
- Insertional tendonitis occurs when the middle fibers in the tendon begin to break down. This will lead to micro-tearing within the tendon, swelling, and pain. It is most commonly seen in active, younger individuals. Achilles Tendonitis exercises will target increasing the load tolerance of the tendon by improving strength and endurance.
Non-insertional Achilles Tendonitis
- Noninsertional tendonitis can occur in anyone, however, it is the most common form with overweight individuals. The Achilles tendon becomes inflamed and painful in the area where it connects with the heel bone (calcaneus). If this becomes chronic (longer 2-3 months), a bone spur typically develops at the insertion point on the bone. Achilles Tendonitis exercises will target improving flexibility, reducing inflammation, and then finally increasing strength and endurance of the tendon.
How to Diagnosis Achilles Tendonitis?
Diagnosis of Achilles Tendonitis is fairly simple. Palpation (pinching) of the tendon between your fingers that elicits pain and tenderness is a clinical sign of this condition.
If swelling is present around the tendon, this would give you additional confidence in the diagnosis. Performing a standing heel raise would produce pain within the tendon.
X-ray could confirm or rule out the presence of a bone spur at the insertion of the Achilles tendon on the heel bone (calcaneus). X-rays only show bone, but not soft tissue.
Ultrasound Imaging could easily show the presence of inflammation and/or thickening of the Achilles tendon. This is a relatively cheap and quick way to get a diagnosis from a doctor.
Magnetic Resonance Imaging (MRI) would not be needed for the simple diagnosis of Achilles Tendonitis. Positive results from an MRI would not change the treatment protocol in this case. However, it would be warranted if there was a concern for an Achilles tendon rupture.
Tendonitis vs. Tendinopathy
Achilles Tendonitis (tendinitis)
- Initial stage (0-3 months), presence of pain and inflammation within the tendon
Achilles Tendinopathy
- Chronic stage (usually > 3 months) as the inflammatory phase dies out, but the tendon has failed to heal. Tendon thickening is a hallmark indicator of tendinopathy. Typically this occurs because of repetitive trauma and overuse of the tendon.
Treatment Options
The first treatment intervention should be to stop performing the most aggravating activities. Sometimes this means to shut down the activity completely, however, not necessarily. If the condition is in an earlier stage, the individual may be able to perform the activity in a modified manner (ie. less distance, less duration, less intensity), but ensuring that they stop prior to the onset of aggravation or pain in the tendon.
Alternatively, other activities can be performed in replacement of the aggravating ones. For example, if someone is having pain walking, they likely would be able to still ride a recumbent bike so that they can remain active and maintain cardiovascular health instead of just shutting down exercise altogether.
Semi-custom insoles are a great option for someone with flat feet. These insoles replace the standard, unsupportive insoles that most shoes come with normally. Semi-custom insoles provide much better arch support, which will help with boot plantar fascia and Achille tendon pain.
Superfeet Insoles
These are my absolute favorite insoles. My wife and I use them in all of our work shoes, tennis shoes, and hiking boots.
- TRIM TO FIT
- SEMI-CUSTOM ORTHOTIC SUPPORT
- PREMIUM ARCH SUPPORT INSOLES
- MOISTUREWICK TOP COVER REDUCES ODORS
- HELPS STABILIZE THE FOOT
- QUALITY CONSTRUCTION
Heel cups
- Heel Cups are a great short-term option to decrease tension in the Achilles tendon. You place one in each shoe as it will ever-so-slightly elevate the heel and take some stress off of the tendon. Keep them in the shoes that you wear most often.
- PROCARE GEL HEEL CUPS – S/M
- MEDICAL-GRADE SILICONE
- GREAT FOR HEEL SPURS, PLANTAR FASCIITIS & ACHILLES TENDONITIS
- INCLUDES PAIR (2 TOTAL)
Voltaren Gel
- An over-the-counter nonsteroidal anti-inflammatory (NSAID) gel that soaks through the skin and reduces the inflammation of the soft tissue beneath the application area. It is very effective for relatively superficial tissues (i.e. Achilles Tendonitis). Be sure to check with your doctor to make sure it is safe for you to take anti-inflammatory medications before doing so.
ASO (Ankle Stabilizing Orthosis)
- This type of ankle brace can be worn to decrease stress on the Achilles tendon during weight-bearing activities. Wearing one of these gives some support to the ankle and can help improve tolerance to walking or running.
- COMFORTABLE PROTECTION
- BREATHABLE DESIGN
- TWO “FIGURE-SIX” SUPPORT STRAPS
- ADJUSTABLE FIT
- DECREASES STRESS ON THE ANKLE
- LEVEL 3: MAX PROTECTION
Walking Boot
- A walking boot is sometimes needed whenever an individual has been suffering from Achilles Tendonitis for several months. These individuals just can’t seem to get away from performing aggravating activities.
- USE FOR LOWER LEG INJURIES AND POST-OPERATIVE
- STREAMLINED, SEMI-RIGID SHELL
- LIGHTWEIGHT CONSTRUCTION
- MEDIAL/LATERAL AIR BLADDERS OFFER CUSTOMIZED COMPRESSION
- ROCKER SOLE TO PROMOTE NATURAL GAIT
Wearing a walking boot “shuts the ankle down” preventing any increased stress through the Achilles tendon. It is to be worn at all times when the person is awake. Typically the walking boot is used for 2-4 weeks and then progresses to an ASO brace when they can back to wearing normal shoes.
The treatment options previously mentioned are all great for helping to reduce the pain and irritation of the Achilles tendon, however, they are not the “end-all, be-all” so to speak.
Ultimately, there are several key Achilles Tendonitis exercises that should be performed throughout this painful process. Exercises are meant to help promote pain relief initially during the inflammatory phase and then to help improve the tendon’s strength and endurance to prevent future injuries.
The BEST Achilles Tendonitis Exercises for Pain Relief!
- Convenient Access: Print or Use On-the-Go on Any Mobile Device
- Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
- Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
- Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
- Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Convenient Access: Print or Use On-the-Go on Any Mobile Device
Customized Healing Plans: Easy-to-Follow, Tailored Exercise Guides
Holistic Recovery: Reduce Pain, Improve Mobility, & Increase Strength
Comprehensive Progression: All-in-One Rehab Worksheets Include a Progressive Exercise Sequence for Optimal Results
Expertly Designed by Dr. Tim Schuckers, PT, DPT, OCS
Plantarflexion Submaximal Isometrics with Strap
Use this: OPTP Stretch-Out Strap
- Perform submaximal (approx. 30-50% effort) isometric press into the strap
- Isometric = Do Not Allow Any Ankle Movement
- Stay BELOW onset of pain in the tendon
- 10 reps x 10 sec hold each (1-2x/day)
Single Leg Eccentric Heel Raise Exercise
- Perform dual heel raise, pause at the top
- Shift 100% weight onto the painful side
- Lift nonpainful foot up off of the ground
- Slowly lower heel back down to floor (3-sec drop)
- Perform 3 sets x 10 reps (1-2x/day)
Dual Leg Heel Raise Exercise
- Perform dual leg heel raise if single leg eccentric is too painful
- 3 sets x 10 reps (1-2x/day)
Seated Bent Knee Single Leg Heel Raise
Use this: Intent Pullup Assist Bands
- 3 sets x 10 reps (1-2x/day)
Ankle Plantarflexion with Band Resistance Exercise
Use this: Theraband Flat Resistance Bands
- 3 sets x 10-15 reps (1-2x/day)
Ankle Inversion with Resistance Band
Use this: Theraband Flat Resistance Bands
- 3 sets x 10-15 reps (1-2x/day)
Standing Straight-Knee Calf Stretch
- Stretch leg is the back leg
- Knee must be fully straight
- Should feel stretch in upper calf muscles
- 3 reps x 30 sec holds (2x/day)
Standing Bent-Knee Calf Stretch
- Stretch leg is the back leg
- Bend knee and shift weight backwards as if you were going to kneel down
- Should feel stretch in lower calf muscles
- 3 reps x 30 sec holds (2x/day)
