Tendons are the tough, elastic cords of tissue that connect your bones to your muscles. They transmit the force of your muscles to your bones to aid with movement and to provide stability.
The Achilles tendon is the largest and strongest tendon in your body. It connects your heel bone to your calf muscle and runs down the back of the lower part of both your legs.
This tendon helps you walk, run, jump, and lets you lead a generally active lifestyle. Because of the amount of force these tendons undergo on a daily basis, it is built to endure great force.
However, if the Achilles tendon is overworked or put under too much strain at once, then it may become inflamed, snap, or even deteriorate, resulting in back of ankle pain that is hard to ignore.
Below is a short guide to help you identify what types of Achilles tendon pain and Achilles heel pain there are, each of these conditions’ symptoms, as well as various treatment methods that you can try at home.
Keep in mind, however, that if your pain is severe, you should consult your doctor for a proper diagnosis.
Common Causes of Achilles Tendon and Heel Pain
Participation in Certain Sports and Excess Exercise
Running, especially constant running on uneven ground or running uphill, is typically the most common cause.
Other sports that put a lot of stress on your feet, like basketball, tennis, dancing, or even excessive walking can also lead to a sore Achilles tendon.
It is important to always properly stretch and warm-up before you exercise, as a sudden strain to your legs may lead to Achilles tendinitis or even a tearing of the tendon itself.
Similarly, a sudden sharp increase in physical activity without a proper warm-up will result in a number of other foot or leg problems as well.
Ill-Fitting Shoes
Wearing poorly-fitted or old shoes when exercising or walking around for long periods of time is also a prominent cause for all kinds of back of ankle pain.
High heels or other pointed-toed shoes are another bad shoe choice.
Overpronation or Weak Muscles
Having flattened arches, feet that roll in too far (which is a condition known as overpronation), and weak calf muscles can also put strain on the tendon, resulting in either type of Achilles tendinitis.
Pre-Existing Conditions
Rheumatoid arthritis can be the cause of a number of different types of foot pain, including any Achilles tendon pain or Achilles heel pain you may be feeling.
Bone spurs, or hard outgrowths of bone that occur at the edges of the bone, in the back of your heels may also be a significant cause.
Typically, bone spurs crop up at the joints, and the heel is a common target for them to develop.
Types of Achilles Tendon and Heel Pain
Achilles Tendinitis
This is perhaps the most common type of Achilles tendon pain. Typically, this pain is caused by overuse, usually due to constant athletic activity.
There are two types of Achilles tendinitis: noninsertional tendinitis and insertional tendinitis.
Noninsertional tendinitis is the inflammation of the middle part of your tendon. It is more common in younger, athletic people.
Insertional tendinitis is when the inflammation of the Achilles tendon spreads all the way down to the Achilles heel bone.
Symptoms
If you have either form of Achilles tendinitis, you may feel weakness or stiffness in the backs of your legs.
This weakness may be more prominent in the morning, immediately after waking and lessen throughout the day.
Alternatively, your legs may move slower than you want them to, or you may find that you cannot flex your foot all that much.
You may feel sore a few centimeters above where the tendon meets the heel bone, even when you have not moved for a while, or when you walk up steps or uphill.
Another problematic symptom is intense pain the day after a strenuous workout. The area around your Achilles tendon may also become swollen and warm to the touch.
Treatment
Your doctor will ask about what activities you perform on a daily basis, including your occupation and hobbies. Then, they will check if there is swelling in the backs of your heels, or if you experience any back of ankle pain when they press on it.
They may also test the range of motion your ankle can perform by asking you to stand on the balls of your feet. If they find your movement is limited in any way, then it is possible you may have either form of Achilles tendinitis.
They may order that you get an X-ray of your foot and leg bones or an MRI scan to detect if your pain due to a tendon rupture or just general degeneration. Alternatively, an ultrasound can be ordered to assess if your pain is actually due to any related damage or if it is indeed inflammation.
If you do have either type of Achilles tendinitis, then your doctor will most likely tell you to stop doing any strenuous activity that causes any stress on your tendons.
This will mean that you will have to temporarily stop participating in any high-impact sports. You will also have to avoid walking up any sort of incline, including stairs, if at all possible.
Recovery times after treatment can vary. Do not rush your recovery process by heading directly back into your workout routine. Introduce it slowly back into your day after you are sure you have fully recovered.
You should also apply ice to the swollen areas for fifteen minutes at a time several times a day. When not in use, elevate your affected leg or legs to a level that is a little above your heart. This will help reduce the swelling.
If the pain becomes uncomfortable, you may also take an anti-inflammatory medication such as ibuprofen to reduce swelling. Carefully stretching your ankles and calf muscles daily can be helpful, too.
You may also choose to compress the tendon with athletic wraps or surgical tape or use a nightly splint, too.
In especially severe cases, your doctor may also order that you wear a walking boot or cast or participate in physical therapy.
Avoid walking barefoot at all costs, and opt for wearing heel lifts inside your shoes. You may purchase custom fits, or, for those on a budget, the generic store brand fits like Dr. Scholls will work fine as well.
Paratenonitis
This acute Achilles injury is very similar to Achilles tendinitis. In fact, this condition may sometimes be mistakenly diagnosed as Achilles tendinitis.
The Achilles tendon is surrounded by a thin sheath of tissue called the paratenon. Paratenonitis, therefore, is the inflammation of this thin sheath of tissue rather than the Achilles tendon itself.
Some medical practitioners do not believe there is a difference between paratenonitis and Achilles tendinitis, and, as such, it is not commonly diagnosed.
The only definitive way to diagnose this is to undergo a biopsy, where your doctor takes a small sample of tissue from the affected area to examine it more closely.
Symptoms
The symptoms of paratenonitis are the same as those of Achilles tendinitis.
In especially severe cases, the tendon can swell to the point where it looks almost like a sausage.
Treatment
The treatments listed for Achilles tendinitis also apply to paratenonitis as well.
Achilles Tendon Rupture
The type of pain one feels when your Achilles tendon ruptures or snaps is similar to that of Achilles tendinitis.
However, the consequences of this rupture are more serious than that of Achilles tendinitis, so you should always consult your doctor about your pain to receive a proper diagnosis.
Symptoms
You may hear a popping sound when you first tear the Achilles tendon, resulting in severe back of ankle pain that may make it very difficult to walk.
Your tendon may become swollen, discolored, or feel tender. There may even be an internal gap at the back of your ankle where the tendon ends after the initial tear.
Treatment
The diagnosis of this rupture is typically made after similar tests your doctor may have you undergo if you had Achilles tendinitis. Typically, MRI scans and ultrasounds will work best for this.
Surgery is the more common type of treatment, though there is a non-surgical alternative as well.
The non-surgical treatment involves the foot or ankle being flexed downward in a cast or boot, which can stay on from anywhere between eight to twelve weeks. Afterwards, a series of physical therapy sessions will follow.
Surgical treatment is recommended for younger to middle-aged patients. The ruptured tendon is sutured in this surgery and then set into a splint cast or walking boot.
Physical therapy may also be recommended post-surgery. It may take anywhere from four to six months for your injury to fully recover.
Tendinosis
While most Achilles tendon pain is associated with the inflammation of the tendon, your Achilles tendon can also degenerate over time, either due to age or excessive trauma to the area through extensive overuse.
Athletes are more susceptible to this because they do not allow themselves proper recovery time after working out.
Symptoms
The pain felt in tendinosis is very similar to that of Achilles tendinitis.
Treatment
Again, the diagnosis process is very much the same as the other injuries listed above. Typically, an MRI scan is the best detector of this tendon deterioration.
The structural changes that occur due to this deterioration are largely irreversible. The painful symptoms themselves may resolve, thus letting you return to playing sports.
However, do keep in mind that these symptoms sometimes recur after such activities are resumed.
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