Pain at the back of the ankle should not always be called “heel pain”
The Achilles tendon connects the calf muscles to the heel bone and plays an important role in walking, running and pushing the body forward.
Problems involving the Achilles tendon can range from gradual overuse-related pain to partial or complete tendon tears. The location and nature of the pain can provide important clues about the underlying problem.
Common Achilles tendon problems
Achilles disorders include:
- Achilles tendinopathy
- Insertional Achilles tendinopathy
- Mid-portion Achilles tendinopathy
- Retrocalcaneal bursitis associated with insertional disease
- Partial Achilles tendon tears
- Acute Achilles tendon rupture
- Chronic or neglected Achilles tendon rupture
What are the symptoms?
Depending on the condition, symptoms may include:
- Pain at the back of the ankle or heel
- Morning stiffness
- Pain during or after activity
- Tenderness along the tendon
- Swelling or thickening of the tendon
- Pain when climbing stairs or running
- Difficulty pushing off while walking
- Sudden loss of strength after an injury
Why do Achilles problems occur?
Achilles tendon problems can be associated with a number of different factors.
How is an Achilles tendon problem diagnosed?
Diagnosis usually starts with history and clinical examination.
Your assessment may include:
- Exact location of pain
- Duration and progression of symptoms
- Recent change in activity
- Achilles tendon tenderness and thickening
- Calf strength
- Ankle movement
- Foot alignment
- Single-leg heel-rise ability
- Gait assessment
Treatment for Achilles tendinopathy
Treatment is usually based on the severity and type of tendon problem.
The goal is generally not complete avoidance of tendon loading. Instead, rehabilitation aims to progressively restore the tendon’s ability to tolerate load.
Treatment may include
- Temporary modification of aggravating activities
- Progressive calf strengthening
- Physiotherapy
- Flexibility work where appropriate
- Footwear modification
- Heel elevation in selected situations
- Gradual return to running or sport
When might surgery be considered?
Most Achilles tendinopathy does not automatically require surgery.
Surgery may be considered in selected patients with persistent symptoms despite appropriate non-operative treatment or when there is significant structural tendon disease.
Depending on the location and severity, surgery can involve removal of diseased tendon tissue, treatment of associated bony prominence or reconstruction/augmentation when substantial tendon damage is present.
Achilles tendon rupture
A sudden Achilles rupture is different from chronic tendinopathy.
Treatment options depend on factors such as the patient’s age, activity level, tendon gap and functional requirements. Both non-operative treatment and surgery can be considered in appropriate patients.
Chronic or neglected Achilles rupture
A rupture that has remained untreated for a prolonged period can become more complex.
The tendon may retract and develop a gap, and direct repair may no longer be possible.
Depending on the size of the defect and remaining tendon quality, reconstruction may require techniques such as tendon transfer, graft reconstruction or other augmentation procedures.
When should you see a specialist?
Seek assessment if you have:
- Persistent Achilles pain
- Increasing tendon swelling or thickening
- Pain that repeatedly returns when you run
- Difficulty performing a single-leg heel rise
- Sudden loss of push-off strength
- A sudden “pop” or snap in the back of the ankle
- Difficulty walking after an acute injury
Frequently Asked Questions
Is every Achilles pain caused by tendinitis?
No. Achilles pain can arise from different parts of the tendon and surrounding structures. A correct diagnosis matters because treatment varies.
Can I continue running with Achilles pain?
Continuing the same training load despite increasing pain may aggravate the condition. Activity should generally be modified according to symptoms and rehabilitation goals.
Does Achilles tendinopathy always need surgery?
No. Most patients are initially managed without surgery.
Is Achilles rupture the same as Achilles tendinopathy?
No. Tendinopathy usually involves progressive tendon pain and dysfunction, whereas rupture represents a partial or complete structural failure of the tendon.
Can an old Achilles rupture still be treated?
Yes. Chronic ruptures can be reconstructed, although the surgical strategy may be more complex than treatment of an acute rupture.
Consultation
Persistent Achilles pain or sudden loss of push-off strength deserves a proper assessment rather than being treated as routine heel pain.
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