Are you dealing with terrible pain in your ankle and the back of your heel? Achilles tendon pain most often occurs due to injury, and athletes are most likely to experience it. One study showed that Achilles disorders affect around 1 million athletes annually. These injuries are especially common if you participate in activities that involve quickly speeding up, slowing down or pivoting, such as:

• Basketball
• Baseball
• Dance
• Football
• Gymnastics
• Running
• Soccer
• Softball
• Tennis
• Volleyball

Achilles injuries are most likely to occur when you start moving rather than when you stop. Pushing off and lifting your foot, such as when a sprinter starts a race, may be too much for your tendon to handle. High-impact activities can also cause repeated strain to the Achilles tendon and may lead to repetitive stress injuries.

While these injuries most commonly occur in athletes, you don’t have to be an athlete to injure your Achilles tendon. Even something as simple as a hard fall or stepping unexpectedly downward can injure or even rupture your Achilles. Let’s look at some common causes of Achilles tendon pain and how to treat it.

5 potential causes of Achilles tendon pain

While there are many different things that can cause Achilles tendon pain, tendinitis is one of the most common ones. It often occurs due to overuse or damage to the tendon and is an inflammation-based condition. Tendinitis may cause pain that runs down the back of the leg and around the heel. Parts of the tendon may appear to get thicker and harder due to continued stress. There are two types of Achilles tendinitis, and you may experience one or both of them at the same time. Let’s look at the different types of Achilles tendinitis as well as some other potential causes of Achilles tendon pain:

• Noninsertional Achilles tendinitis — With this type of tendinitis, the fibers in the middle of the tendon experience microtears and begin to break down due to inflammation. This can cause pain, swelling, and a thickening of the tendon. Noninsertional Achilles tendinitis tends to affect highly active people, especially younger people and runners.
• Insertional Achilles tendinitis — This type of tendinitis affects the lower part of the heel where the tendon meets the heel bone. Bone spurs, which are extra bone growths, are more likely to form with this type. Insertional Achilles tendinitis is still common with runners, but it can also affect people of any age and activity level. This type of tendinitis often occurs due to tight calf muscles, which put more strain on the Achilles tendon itself.
• Achilles tendinosis — This condition sounds similar to tendinitis, but it’s not quite the same. Achilles tendinitis means that the  tendons are inflamed, which is generally a short-term condition. Achilles tendinosis, on the other hand, means that a person is experiencing long-term, ongoing tendinitis. When this happens, the cells in the  tendons have begun to break down. It can cause thick scarring and takes much longer to heal than tendinitis.
• Achilles bursitis — While tendinitis is a frequent cause of Achilles tendon pain, there are other possible causes. Bursae are fluid-filled sacs that cushion bones and tendons throughout the body. At the back of your heel, a bursa cushions your Achilles tendon so it can easily slide over your heel bone. Overusing your ankle or foot can make the bursa irritated and inflamed, causing pain. Achilles bursitis can also occur due to gout, arthritis, or wearing shoes that are too tight and rub against your heel. 
• Achilles tendon rupture — If a tear in your Achilles tendon is large enough that the tendon tears in half or comes off the heel bone completely, that means it has ruptured. You may hear a popping or snapping noise when this occurs. An Achilles rupture is different and more serious than Achilles tendinitis. The pain with an Achilles rupture is often instant and severe, it may cause bruising or swelling, and you can have trouble pointing or pushing off your toes when you try to take a step. Achilles tendon ruptures can take up to a year to heal. If your Achilles tendon has ruptured, you will require immediate medical attention.

For conditions causing mild to moderate pain, rest, stretching and careful exercise can help your Achilles tendon heal. In severe cases, you may need surgery to correct your injury. 

Symptoms of Achilles tendon pain

Achilles tendon pain can cause you to experience many different symptoms. Here are a few common ones you may have:

• Pain down the back of the leg or near the heel
• Stiffness or pain that gets worse with activity
• A stiff, sore Achilles tendon when you get out of bed
• Pain in your Achilles tendon the day after exercising
• Swelling with pain that gets worse throughout the day
• Thickening of the tendon
• Bone spurs on the heel bone
• Difficulty flexing the injured foot
• A popping sound and sudden, sharp pain
• Stiffness or pain along the Achilles tendon
• Heel pain while wearing shoes

You may experience some or all of these symptoms. If you think you have an Achilles injury, see your doctor for a formal diagnosis.

Physical therapy treatments for Achilles tendon pain

If you have mild to moderate Achilles tendon pain, rest and physical therapy may be enough to help your tendon heal. Here are a few different physical therapy methods that may help your condition:

• Aquatic therapy — Also known as hydrotherapy or aquatic rehabilitation, aquatic therapy can help you strengthen your muscles and reduce pain in your Achilles tendon. Water provides resistance, which can help strengthen your body. Additionally, water is buoyant, which may make it easier to exercise without putting unnecessary pressure on your affected joints and tissue. This makes it easier to do things like standing exercises without putting weight on your Achilles tendon.
• Manual therapy — This type of physical therapy is where your physical therapist uses their hands to move and gently manipulate your joints, muscles and tissue to help stretch and strengthen those areas. Your physical therapist can help you stretch and exercise your foot and ankle in ways that may be challenging for you to do on your own.
• Dry needling — Dry needling is often used for more long-term or chronic conditions, such as Achilles tendinosis. Your physical therapist will insert small “dry” or unmedicated needles into trigger points in your body. The goal of this treatment method is to release those trigger points, relieve pain and improve mobility. While this treatment method can sound scary, you shouldn’t feel pain during it, though you may experience some soreness afterward.
• Virtual physical therapy — Can’t come into our office? Virtual physical therapy can meet you where you are. Receive the same high level of care in the comfort of your home while you strengthen and heal your Achilles tendon.

A combination of these different physical therapies can help you regain your mobility and strength in your Achilles tendon. At Rehab Access, we can create a treatment plan that’s right for your condition and limitations. Our licensed physical therapists are highly trained in evidence-based treatments that can help you get back to running that half-marathon.

An Achilles injury doesn’t have to sideline your athletic life. Call us or request an appointment today to get your body back in the game.