Achilles Tendon Pain Patterns

Achilles tendon injuries are one of the most common conditions that runners, athletes, and physically active adults experience. Patterns of pain can help determine if your discomfort is due to overuse, tendon degeneration, or sudden injury. Knowing how your symptoms developed, along with when and where you experience pain, can help identify the issue early and seek proper treatment when needed.

Achilles Tendon Anatomy

The Achilles tendon anchors your calf muscles to your heel bone. It supports your body during walking, running, and jumping motions. The Achilles tendon is actually the strongest tendon in your body.

However, like any structure in your body, too much stress can cause problems.

There is a limited blood supply to your Achilles tendon. Due to this, when injuries occur, they may take longer to heal. If your Achilles tendon is overstressed, repetitive micro-tears can occur in the tendon fibers. Over time these small injuries can weaken the tendon and lead to patterns of chronic pain.

When Too Much Stress is Applied To The Achilles Tendon

When the forces applied to your Achilles tendon exceed its capacity, microscopic damage can occur to the collagen fibers. Your body will try to repair this damage over time. However, if your tendon is continually stressed before it has healed, weaker tendon tissue may develop.

Mid-Portion Achilles Tendinopathy

Mid-portion tendinopathy refers to Achilles tendon pain that occurs in the middle of your Achilles tendon. This is the most common location for Achilles tendon injuries to occur. Midportion tendinopathy is usually felt two to six centimeters above your heel bone. This area tends to have the least blood supply to the Achilles tendon.

People with this injury typically experience pain when running, jumping, or pushing off their feet. You may notice tenderness to the area or slight thickening of the tendon. Stiffness is also common with midportion tendinopathy and is often worse in the morning or after sitting for long periods of time.

Insertional Achilles Pain

Insertional tendinopathy occurs where the Achilles tendon inserts into your heel bone. Pain is generally felt at the back of your heel and may get worse when wearing shoes that fit tightly around your ankle. It may also hurt when you curl your toes toward your leg.

This injury can also cause bone spurs or calcium deposits to form along the area where your Achilles tendon inserts. Shoe gear modifications and treatment strategies may vary with this injury because compression is thought to contribute to the problem.

The Warm-Up Effect

Some people experience what is known as the warm-up effect with Achilles tendinopathy. You may notice pain with the first steps out of bed or initially during exercise but find the pain gets better as you continue your activity.

While this may feel like your injury is improving, this is not always the case. Your Achilles tendon can still be injured even if it feels better once it warms up. If you increase your activity too quickly after injury, you can reinjure your tendon.

Morning Stiffness/Post-Rest Pain

Morning stiffness is another common sign of Achilles tendonitis. After waking up or resting for long periods of time, your Achilles tendon will tighten up.

You may feel stiffness or soreness with your first steps out of bed or after sitting at your desk all day. This stiffness usually resolves after you loosen up your tendon with light activity or stretching.

Conditions That Mimic Achilles Pain

Because there are many anatomical structures around your Achilles tendon, other injuries can mimic tendon problems. Retrocalcaneal bursitis is inflammation of a small fluid filled sac located between the Achilles tendon and your heel bone.

Other disorders, such as nerve compression, muscle strains, and lower back problems, can cause similar symptoms to those you would feel with an Achilles tendon injury. A thorough history and physical examination by your doctor can help rule out these conditions.

Warning Signs of Achilles Tendon Rupture

Although rupture of the Achilles tendon is rare, sometimes pain can be an indicator of this injury. Achilles tendon rupture typically happens suddenly while participating in explosive activity like sprinting or jumping.

Patients often recall hearing or feeling a pop at the back of their ankle. They are then unable to walk properly or push off their feet because of the intense pain they feel. If you think you may have ruptured your Achilles tendon, you should seek medical attention immediately.

Risk Factors For Injury

Certain biomechanical factors can predispose you to developing problems with your Achilles tendon. Limited ankle dorsiflexion, tight calf muscles, and poor foot mechanics can all lead to excessive stress being placed on your Achilles tendon.

Training errors can also lead to excessive loads on the Achilles tendon. Increasing your mileage too quickly, changing running surfaces abruptly, and wearing broken shoes can all trigger injury to the tendon.

Treatments For Achilles Tendon Pain

The first step in treating your Achilles tendon pain is to decrease the number of activities that cause you pain. Wearing supportive shoes, temporary heel lifts, and stretching can help take some stress off your Achilles tendon.

Physical therapy can also be very beneficial in the treatment of Achilles tendon injuries. Calf stretching and strengthening exercises are usually started to improve your tendon strength. Eccentric exercises, as well as heavy slow resistance training, have been shown to be very effective at restoring tendon function.

Your physical therapist can also treat any limited joint mobility, balance deficits, or movement dysfunctions that may have contributed to your tendon injury.

Preventing Future Injury

Full recovery from Achilles tendinopathy can take time. The tendon grows slower in response to stress than muscles do. By continuing the calf exercises, your tendon will continue to adapt and get stronger.

It is important to continue these exercises even after you feel better to prevent re-injury. Increasing your activity level slowly and wearing the proper shoes will also help prevent future injuries. Paying attention to how your ankle feels during activity can help you notice when your tendon is starting to become irritated before it progresses into a chronic injury.

Here at Wasatch Foot & Ankle Institute, we treat patients with Achilles tendon pain by performing a thorough physical examination, ordering imaging when needed, and creating an individualized treatment plan to get you back to activity as soon as possible.

Frequently Asked Questions

Q1: What does Achilles tendon pain feel like?

A: Achilles tendon pain is usually described as stiffness, tenderness, or an ache along the back of your ankle. Some people will notice swelling or thickening of their Achilles tendon when they are active.

Q2: Why is my Achilles tendon sore in the morning?

A: It is sore in the morning because your Achilles tendon stiffens up while you are resting. When you take your first steps out of bed, your Achilles tendon suddenly gets stretched. It is this initial stretching that can cause pain until it warms up.

Q3: How will I know if my Achilles tendon is torn?

A: Achilles tendon ruptures are often associated with a popping sensation in the back of your ankle. After you injure your tendon, you may experience sharp pain and have trouble walking or pushing off your foot.

Q4: How long does it take for Achilles tendinopathy to heal?

A: Achilles tendinopathy can take anywhere from 8 to 12 weeks to heal. It is important that you stick with your rehabilitation program and do not overload your tendon too early. Severe cases of Achilles tendinopathy can take several months to fully recover.

Q5: When should I see a foot and ankle specialist for Achilles tendon pain?

A: If your pain lasts for several weeks and continues to hurt when you are active, it is time to see a specialist. Your foot and ankle doctor can diagnose the cause of your pain and begin creating a plan to help you return to activity. Seeing your doctor early can help prevent further damage to your tendon and allow for a quicker recovery.