Key Takeaways
A quick overview of what this page covers.
Achilles tendinitis usually develops gradually, causing pain, stiffness, swelling, or irritation in the back of the ankle or lower leg rather than a sudden injury.
There are two main types: insertional Achilles tendinitis, where the tendon meets the heel bone, and non-insertional tendinitis, which affects the middle portion of the tendon.
Most cases improve without surgery. Treatment often includes activity modification and progressive tendon loading, and chronic cases may take 3 to 6 months to improve substantially.
At Greschner Foot & Ankle Specialists in Morgantown, Dr. Greschner tailors treatment to your symptoms and may recommend conservative care, regenerative medicine, or surgery when needed.
Achilles tendinitis is an overuse condition that causes pain, stiffness, swelling, and irritation in the Achilles tendon, the strong band of tissue connecting the calf muscles to the heel bone.
While many people call this condition “tendinitis,” chronic Achilles pain is often more accurately called tendinopathy. That means the tendon has become irritated and weakened over time, rather than simply inflamed. This distinction matters because it changes how long-term treatment works.
Achilles tendinopathy usually develops gradually. You may notice nagging pain or stiffness in the back of your ankle or lower leg, rather than pain from one sudden injury. If you felt a sudden “pop” or sharp pain, you may want to review our information on Achilles tendon ruptures instead.
For chronic Achilles pain, the good news is that most cases respond well to conservative care. At Greschner Foot & Ankle Specialists in Morgantown, you will receive an evaluation and a treatment plan tailored to your symptoms.
Insertional vs. Non-Insertional Achilles Tendinitis
“Achilles tendinitis” isn’t one single condition. Doctors classify it by where the irritation or damage occurs along the tendon. This difference can affect which treatments are safest and most helpful.
Insertional Achilles Tendinitis
- This type involves pain and irritation where the tendon meets the heel bone.
- It is often associated with bone spurs at the back of the heel, thickening of the tendon, or a bony enlargement called Haglund’s deformity. Patients may sometimes refer to this type of bone spur as a “heel spur,” although heel spurs can also occur in other areas of the heel.
- While it can occur in athletes, it is more common in older or less active patients.
Non-Insertional Achilles Tendinitis
- This type involves pain and irritation in the middle portion of the tendon, roughly 2 to 6 centimeters (about 1 to 2 inches) above the heel.
- It is more common in younger, highly active patients.
- Non-insertional tendinitis often involves degenerative, wear-and-tear changes within the tendon fibers.
- These cases often respond well to a guided strengthening plan, which may include eccentric exercises like slow heel-lowering movements.
Signs and Symptoms of Achilles Tendinitis
Achilles tendinitis can feel a little different from person to person, but there are a few common symptoms. You may notice a gradual onset of pain along the back of the lower leg or heel. Many patients also have morning stiffness or stiffness after sitting for long periods, which tends to improve once they start moving.
One common pattern with Achilles tendinopathy is the warm-up/warm-down pain pattern. With this pattern, pain may improve during the first few minutes of light activity, then return more strongly afterward.
Additional signs include:
- Tenderness when pressing along the affected tendon.
- Mild swelling in the affected area.
- Thickening you can see or feel along the tendon, especially in chronic cases.
- Pain when rising onto your tiptoes or pushing off during a normal walking motion.
Unlike a rupture, Achilles tendinitis usually develops gradually, without a sudden “pop.” You can typically still rise onto your toes and push off when walking, even if it is uncomfortable. Trouble rising onto your toes or sudden weakness when pushing off can be warning signs of a possible tendon rupture.
Is It Actually Your Achilles? Other Conditions That Can Mimic It
Several conditions can cause pain near the back of the heel or lower leg. A specialist exam can help identify what is actually causing your symptoms.
- Plantar fasciitis: This condition typically causes pain on the bottom of the heel that is worst during your first morning steps, rather than pain at the back of the heel.
- Retrocalcaneal bursitis: This is inflammation of a small fluid-filled cushion, called a bursa, where the Achilles tendon meets the heel bone. It can occur along with insertional Achilles tendinitis and is sometimes the main source of pain.
- Haglund’s deformity: This is a bony enlargement at the back of the heel. It often looks or feels like a noticeable bump and can occur along with insertional tendinitis.
- Posterior ankle impingement: This causes pain at the very back of the ankle joint. It is more common for dancers, jumpers, or athletes who point their foot forcefully downward.
- Sural nerve irritation: This usually feels more like burning or tingling than soreness that changes with activity.
Because these conditions can overlap, a focused exam is often the best way to sort out what is causing your pain and what treatment makes the most sense.
When to See a Specialist
You may be wondering whether you need to see a doctor or if you should keep trying to rest your ankle. You should see a specialist if you experience:
- Pain that lasts more than a few weeks despite rest and self-care.
- Pain that limits your daily activity, work, or exercise you enjoy.
- Increasing swelling or visible thickening of the tendon.
- Pain that worsens rather than gradually improving.
You should seek prompt care for any sudden changes, such as sharp pain, a “pop” sensation, sudden weakness when pushing off, or an inability to walk normally. These can be signs of a possible rupture, which needs timely care. If your pain comes on gradually and feels manageable, the self-care steps below may be a reasonable place to start.
Self-Care You Can Try at Home
If you are hoping to manage your symptoms at home, there are several practical first steps that may help. Many patients find these steps helpful:
- Cut back on activities that make the tendon hurt, but do not stop moving completely. Gentle activity is usually better than full rest.
- Apply ice after activity for 15 to 20 minutes, using a barrier between the ice and your skin.
- Take over-the-counter anti-inflammatory medications if they are safe for you, but check with a doctor before longer-term use or if you have existing health conditions.
- Try gentle calf stretching only if it feels comfortable. Stretching may help some people, but if it increases your Achilles pain, especially near the heel, stop and ask a specialist or physical therapist what is safe for your situation.
- Wear heel lifts or supportive shoes with a slight heel, and avoid fully flat shoes during a flare-up.
If your pain is in the middle of the tendon, called non-insertional or midportion Achilles tendinitis, strengthening may help the tendon tolerate activity again. Here are two common ways these exercises may be performed:
- Heel raises: Slowly lift your heel from the floor, then lower it back to the starting position.
- Heel drops: Rise onto your toes, then slowly lower your heel, often below the edge of a step.
If your pain is right where the tendon attaches to the heel, standard heel drops off a step may make symptoms worse unless they are modified. It is best to ask your doctor before trying them.
As a general guide, mild pain during activity may be acceptable if it stays around 3 out of 10 or below, does not change the way you walk, and settles within 24 hours. Pain above that level, pain that changes your gait, or pain that keeps getting worse is a sign to back off. If your pain has not improved in 2 to 4 weeks, is getting worse, or is interfering with daily life, it is time to call a specialist.
Causes and Risk Factors
Understanding why your Achilles tendinitis developed can help you prevent it from returning. A common pattern in Morgantown is going from a mostly seated workweek to a long walk, run, hike, or rec-league game on the weekend.
Common Causes
- A sudden increase in how often, how long, or how hard you exercise.
- Repetitive stress from running, jumping, or hill-climbing sports.
- Sports involving sudden starts and stops, such as basketball, tennis, pickleball, or soccer.
- Skipping a warm-up or changing activity too quickly.
- Worn or unsupportive footwear.
Risk Factors
- Tendons can lose some elasticity beginning in your 30s, which may make them more vulnerable over time.
- Tight calf muscles or limited ankle flexibility.
- Flat feet or high arches, which can affect how force loads the tendon.
- Carrying extra body weight, which can increase the load on the tendon.
- Medical conditions such as diabetes, high blood pressure, or chronic kidney disease.
- Certain medications, including corticosteroid use and fluoroquinolone antibiotics, such as ciprofloxacin or levofloxacin, have been associated with tendon issues. However, do not stop a prescribed medication without talking with the clinician who prescribed it.
- Achilles tendinitis is somewhat more common in men.
How Achilles Tendinitis Is Diagnosed
Your visit with Greschner Foot & Ankle Specialists typically starts with a conversation about how your pain began, what activities make it better or worse, and any medications or medical conditions that may affect your tendon health. Your specialist will also do a physical exam, which may include gently pressing along the tendon to find the painful area, checking your range of motion, testing your calf strength, and using a simple calf-squeeze test, called the Thompson test, to help rule out a rupture.
Achilles tendinitis can often be diagnosed based on your symptoms and exam, so imaging is not always required. When imaging is needed, your specialist may use:
- Ultrasound to assess tendon thickness and structure.
- MRI for severe, chronic, or surgical-planning cases.
- X-rays to check for bone spurs or a bony enlargement at the back of the heel, such as Haglund’s deformity, when insertional Achilles tendinitis is suspected.
Non-Surgical Treatment Options
In most cases, Achilles tendinitis can be treated without surgery. It is important to have realistic expectations, especially if your pain has been going on for a while. Most patients with chronic tendinopathy need 3 to 6 months of consistent conservative care before they feel a major improvement. Some people improve faster, while others need more time.
Your non-surgical treatment plan may include:
- Continued activity modification, often with more structure than what you tried at home.
- Physical therapy focused on progressive tendon loading. This means gradually strengthening the Achilles tendon so it can tolerate more activity again, without overloading it too quickly. Depending on your symptoms and where the tendon is irritated, your plan may include heel raises, heel drops, resistance exercises, balance work, or other guided strengthening. The right exercises are adjusted to your pain level, tendon irritability, strength, and activity goals.
- A modified loading plan for insertional Achilles tendinitis. If your pain is where the tendon attaches to the heel, your therapist may have you avoid dropping the heel below neutral because that position can compress and irritate the tendon.
- Targeted stretching and calf flexibility work, when appropriate for your symptoms.
- Anti-inflammatory medications to help with short-term pain or flare-related discomfort. These can help symptoms, but they do not rebuild tendon strength or replace a loading-based rehab plan.
- Custom orthotics or heel lifts to reduce strain on the tendon.
- Bracing or a walking boot for short periods in more severe cases.
- Regenerative medicine, including injections of platelet-rich plasma, or PRP, for select patients. PRP uses a concentrated sample of your own platelets, which contain growth factors involved in the body’s healing response.
Greschner Foot & Ankle Specialists does not use cortisone injections in or around the Achilles tendon because cortisone can weaken tendon tissue and increase the risk of rupture.
Why Rest Alone Often Isn’t Enough
A common pattern is resting for a few weeks until the pain settles, then feeling the pain return when activity starts again. That happens because chronic Achilles tendinopathy usually means the tendon has become irritated and weakened over time, not just inflamed.
Rest can calm symptoms during a flare-up, but it does not rebuild the tendon’s ability to handle activity. Tendons need gradual, controlled strengthening to regain tolerance and function. That is why progressive tendon loading usually works better than rest alone for chronic cases. Rest still matters when pain flares, but the long-term plan often needs to include guided loading with a specialist or physical therapist.
When Surgery May Be Considered
It is understandable to wonder whether you will need surgery, but surgery for Achilles tendinitis is rare. It is generally considered only after six or more months of consistent, well-guided non-surgical care.
Surgery is more common in chronic insertional cases, especially when bone spurs or Haglund’s deformity contribute to the problem. It may also be considered when significant tendon irritation or weakening does not respond to non-surgical treatment. The decision is always individualized based on your age, activity level, severity of damage, and personal goals. Most patients never reach this stage.
Surgical Treatment Options at Greschner Foot & Ankle Specialists
If surgery does become necessary, Dr. Greschner, a board-certified foot and ankle surgeon, performs these procedures right here in Morgantown.
Depending on the procedure and the extent of the tendon damage, Dr. Greschner may use either a traditional open approach, which uses a larger incision to directly access the tendon, or a minimally invasive approach using smaller incisions.
Gastrocnemius Recession
Gastrocnemius recession may be an option when tight calf muscles keep pulling on the Achilles tendon and other treatments have not helped. During the procedure, Dr. Greschner lengthens part of the calf muscle to ease tension on the tendon and improve ankle movement. He will determine whether it is appropriate based on your exam, where your pain is located, and how much calf tightness is contributing to the problem.
Tendon Debridement
This procedure removes damaged or weakened tendon tissue while preserving as much healthy tendon as possible. In non-insertional cases, it focuses on the affected middle portion of the tendon. In insertional cases, debridement is often combined with bone spur removal and tendon reattachment. It is typically considered when imaging confirms significant tendon damage.
Bone Spur Removal and Tendon Reattachment (Insertional Cases)
This option is used for insertional Achilles tendinitis when bone spurs or Haglund’s deformity contribute to symptoms. The bone spur is removed, and the back of the heel bone may be reshaped. If part of the tendon needs to be detached during the procedure, it is reattached to the heel using sutures and anchors. Recovery from this combined procedure is generally more involved than debridement alone.
Tendon Transfer or Augmentation
This option is for severe cases where a large portion of the tendon is damaged. A nearby tendon (often the flexor hallucis longus) may be used to reinforce the Achilles and help restore the strength needed to push off when walking.
Recovery and Returning to Activity
For non-surgical treatment, most patients with chronic tendinopathy improve gradually over 3 to 6 months of consistent conservative care. Some people respond faster, while others need more time.
Surgical recovery is more involved and often requires several months of structured rehab. A full return to higher-impact activity can sometimes take 9 to 12 months.
Physical therapy plays a central role in both surgical and non-surgical recovery. A gradual return to activity is important because symptoms can come back if you do too much too soon or do not address contributing factors like tight calves, footwear issues, or sudden activity changes.
Recovery can feel slow, but a gradual approach helps lower the risk of re-injury or symptoms coming back. The goal is to help you return to walking the Mon River Rail-Trail, hiking at Coopers Rock, or joining your local rec leagues.
Preventing Achilles Tendinitis From Coming Back
Once your Achilles pain improves, these practical steps can help lower the risk of it returning:
- Build activity gradually. A common rule of thumb is to avoid increasing weekly mileage or intensity by more than 10% at a time, but the main goal is to avoid sudden jumps.
- Warm up before activity, especially in cold weather.
- Keep up with calf flexibility work, not just when your tendon hurts.
- Add strength training for your calves and the muscles along the back of your legs, including your hamstrings and glutes.
- Wear supportive shoes and replace worn-out footwear promptly.
- Use cross-training to vary the stress placed on your Achilles.
- Pay attention to early warning signs instead of pushing through pain.
Questions to Ask at Your Appointment
A visit to our office will naturally cover many of the questions patients have about Achilles tendinitis, including diagnosis, treatment options, and recovery. Still, being prepared with a few questions can help you understand what to expect and make the most of your appointment. To get the most out of your visit, consider asking:
- Is my Achilles tendinitis insertional or non-insertional, and does that change my treatment?
- Could my pain be caused by something other than Achilles tendinitis?
- Do I need imaging, such as an X-ray, ultrasound, or MRI?
- Are heel drops, heel raises, or stretching safe for my type of Achilles pain?
- How long should I expect treatment to take before I notice improvement?
- Which activities should I avoid right now, and which can I keep doing?
- Would I benefit from physical therapy, orthotics, or shockwave therapy?
- What can I do to keep this from coming back once it’s resolved?
Frequently Asked Questions
What is Achilles tendinitis?
What's the difference between Achilles tendinitis and an Achilles rupture?
How long does Achilles tendinitis take to heal?
Can I keep running or playing sports with Achilles tendinitis?
How soon can I be seen for Achilles tendinitis in Morgantown?
Schedule a Consultation at Greschner Foot & Ankle Specialists
If you are struggling with chronic Achilles pain or stiffness, seeking evaluation early can help you understand the cause and may make recovery easier. Greschner Foot & Ankle Specialists provides personalized foot and ankle care for patients in the Morgantown area to help you get moving again.
- Call Us: 304-584-3838
- Book Online: Schedule Your Appointment Here. Note: Online booking may show limited appointment availability. If you do not see a preferred time, please call 304-584-3838 — we may have additional options available.
- Patient Resources: Visit our Patient Resources page to access forms and insurance information before your visit.
Content Review
This page was created by the Greschner Foot & Ankle Specialists content team and medically reviewed for accuracy by Dr. Joseph Greschner, DPM.