Achilles Tendonitis

Is pain or stiffness in your Achilles tendon making those first few steps in the morning uncomfortable?

Perhaps you've noticed an aching or pulling sensation at the back of your ankle when walking, climbing stairs or getting up after sitting for a while. You might find that the discomfort gradually eases as you start moving, only to return later after a longer walk or a busy day on your feet.

For some people, the pain begins after increasing their exercise routine. For others, it develops gradually, without any obvious injury.

Whatever the cause, Achilles tendonitis can become frustrating when everyday activities that were once comfortable start causing pain.

If you've been diagnosed with Achilles tendonitis, it's important to understand what's happening within the tendon, which activities may be aggravating the condition and what treatment options are available.

In this article, we'll explain the causes and symptoms of Achilles tendonitis, how it differs from other heel conditions and what may help with recovery. We'll also discuss how OSMO Patch offers a drug-free, non-invasive option for managing swelling and associated discomfort around the Achilles tendon.

What Is Achilles Tendonitis?

The Achilles tendon is the strong band of connective tissue that joins your calf muscles to your heel bone, known as the calcaneus.

It plays an important role in almost every step you take, helping you push your foot against the ground when walking, running, climbing stairs or rising onto your toes.

Although the Achilles tendon is remarkably strong, it is also subjected to considerable force during everyday movement.

When the tendon is placed under excessive or repetitive strain, it can become irritated and painful. This is commonly referred to as Achilles tendonitis.

However, there's an important distinction worth understanding.

The term tendonitis refers specifically to inflammation of a tendon, whereas longer-standing Achilles problems often involve changes within the tendon fibres rather than inflammation alone.

For this reason, healthcare professionals frequently use the broader term Achilles tendinopathy to describe persistent tendon pain and dysfunction. [1]

Understanding this difference is important because treating an inflamed tendon isn't necessarily the same as rehabilitating a tendon that has become weakened or less tolerant of physical activity.

What Are the Different Types of Achilles Tendonitis?

Achilles tendonitis is generally classified into two main types, depending on which part of the tendon is affected.

Midportion Achilles Tendonitis

Midportion Achilles tendinopathy affects the section of the tendon approximately 2–6 centimetres above its attachment to the heel bone.

You may notice pain, tenderness or a thickened area along the back of your lower ankle, particularly when walking or exercising.

The discomfort often becomes more noticeable during activities that repeatedly load the tendon, such as running, jumping or climbing stairs.

Insertional Achilles Tendonitis

Insertional Achilles tendinopathy affects the lower section of the tendon, where it attaches directly to the heel bone.

Pain is generally concentrated at the back of the heel rather than further up the tendon.

This type can be particularly uncomfortable when wearing certain shoes, walking uphill or performing movements that compress the tendon against the heel bone.

Insertional Achilles tendinopathy can also occur alongside retrocalcaneal bursitis, which affects the cushioning sac between the Achilles tendon and heel bone.

For more information about this related condition, see our Retrocalcaneal Bursitis Information article.

Identifying which part of the Achilles tendon is affected is important, as the exercises and rehabilitation approaches used for each type may differ. [2]

What Are the Symptoms of Achilles Tendonitis?

Achilles tendonitis can produce a range of symptoms, depending on the location and severity of the tendon problem.

For some people, discomfort is only noticeable during exercise. Others may experience pain during ordinary activities such as walking, getting out of bed or standing for extended periods.

Common symptoms include:

• Pain along the Achilles tendon: An aching, pulling or occasionally sharp pain at the back of the ankle or heel.

• Morning stiffness: Discomfort during the first few steps after getting out of bed.

• Tenderness to touch: The tendon may feel sore when pressed.

• Swelling or thickening: The affected part of the tendon may appear enlarged or feel thicker than usual.

• Pain during activity: Walking uphill, running, jumping or climbing stairs may aggravate symptoms.

• Discomfort after exercise: Pain may become more noticeable later in the day or the following morning.

• Reduced strength or flexibility: You may find it uncomfortable or difficult to rise onto your toes.

A common feature of Achilles tendinopathy is that symptoms can fluctuate. You might feel reasonably comfortable during one activity, only to experience increased pain or stiffness afterwards.

This can make it difficult to know when you're doing too much.

Why Does Achilles Tendonitis Hurt More in the Morning?

One of the most recognisable symptoms of Achilles tendonitis is stiffness or pain when you first get out of bed.

After several hours of rest, the affected tendon may feel uncomfortable when it is first placed under load.

You may find yourself walking carefully for the first few minutes, particularly when going downstairs or moving across a hard floor.

As you begin moving, the tendon may feel more comfortable and the stiffness gradually eases.

However, this temporary improvement doesn't necessarily mean the tendon has recovered.

If the tendon is subjected to more physical strain than it can comfortably tolerate, the discomfort may return later in the day or become more noticeable the following morning.

Persistent morning stiffness is a common feature of Achilles tendinopathy and can help indicate how the tendon is responding to your activities. [1][2]

What Causes Achilles Tendonitis?

Achilles tendonitis generally develops when the demands placed on the tendon exceed its ability to tolerate and recover from repeated loading.

This can happen suddenly or gradually over time. Several factors may contribute.

Sudden Increases in Physical Activity

Perhaps you've recently started walking longer distances, returned to running after a break or decided to become more active.

Although increasing your activity is generally beneficial, doing too much too quickly can place considerable strain on a tendon that hasn't had sufficient time to adapt.

Repetitive Strain

Activities involving repeated pushing off, running, jumping or climbing can place significant demands on the Achilles tendon.

When these activities are repeated without adequate recovery, the tendon may become increasingly painful.

Calf Muscle Weakness

Your calf muscles and Achilles tendon work together to support movement through the ankle.

If your calf muscles have become weaker through reduced activity, the tendon may be less prepared to tolerate sudden increases in physical demands.

Footwear and Walking Mechanics

Poorly fitting footwear, changes in shoe design or altered walking and running mechanics may influence the forces placed on the Achilles tendon.

In some cases, a firm heel counter can also irritate the tendon close to its attachment to the heel bone.

Age-Related Changes and Other Risk Factors

As we get older, tendons may become less tolerant of sudden changes in physical activity, particularly after extended periods of inactivity.

Certain medical conditions and medications may also increase susceptibility to tendon injuries.

Often, several factors are involved rather than one obvious cause. [1]

Achilles Tendonitis vs Achilles Bursitis – What's the Difference?

Because Achilles tendonitis and heel bursitis can cause pain in similar areas, it's not always easy to tell which condition is responsible.

Achilles tendonitis affects the tendon itself, often causing pain, tenderness and sometimes thickening along the tendon.

Achilles bursitis affects one of the small fluid-filled sacs that cushion the tissues around the heel. Learn more:

 >> Achilles bursitis.

Bursitis may produce more localised swelling or tenderness around the back of the heel, particularly when the affected bursa is compressed or irritated by footwear.

It's also possible to experience both conditions at the same time.

For more information about the different causes of heel bursitis, visit our Achilles Bursitis Information page.

Alternatively, if you're experiencing heel bursitis swelling and associated pain, you may wish to explore:

>> OSMO Patch Heel Bursitis Treatment.

How Is Achilles Tendonitis Diagnosed?

If you're experiencing persistent pain along your Achilles tendon, it's worth having the condition properly assessed.

A healthcare professional will generally begin by discussing your symptoms, medical history and the activities that aggravate your discomfort.

They may examine the tendon for tenderness, swelling or thickening and assess your ankle movement and calf muscle strength.

In many cases, a clinical examination provides sufficient information to make an initial diagnosis. However, further investigations may sometimes be recommended.

Ultrasound: Can help assess tendon thickening, structural changes and surrounding soft tissues.

MRI Scan: May be useful when a more detailed examination is needed or another injury is suspected.

X-rays: Can help identify bone-related changes, including calcification or bone spurs near the Achilles tendon attachment.

Imaging isn't always necessary, particularly when symptoms and examination findings are consistent with Achilles tendinopathy.

What Are the Treatment Options for Achilles Tendonitis?

If Achilles pain has been interfering with your walking, exercise or everyday activities, finding an effective way to manage the symptoms is understandably a priority.

However, because persistent Achilles tendinopathy often involves changes within the tendon rather than inflammation alone, treatment generally needs to do more than simply relieve the pain.

The aim is to reduce excessive strain while gradually restoring the tendon's ability to tolerate normal physical activity.

1. Rest and Activity Modification

Temporarily reducing activities that aggravate your Achilles is often an important first step.

You may need to limit running, jumping, hill walking or other activities that consistently increase the discomfort.

However, prolonged complete rest isn't generally recommended for persistent Achilles tendinopathy, as it can contribute to muscle weakness and reduced tendon capacity.

The aim is to find a suitable balance between reducing excessive strain and maintaining an appropriate level of movement.

If you also have heel bursitis, exercises that irritate the inflamed bursa should be avoided, and any continued activity should be tailored to prevent unnecessary pressure on the affected area.

2. Physiotherapy and Gradual Tendon Strengthening

Physiotherapy is one of the most important treatments for persistent Achilles tendinopathy.

Unlike some acute injuries where a short period of rest may be sufficient, longer-standing tendon problems often require a structured rehabilitation program.

This generally involves exercises designed to gradually improve the tendon's tolerance to physical loading.

Depending on your condition, rehabilitation may include:

• Gentle strengthening exercises appropriate to your symptoms.
• Progressive calf raises or other tendon-loading exercises.
• Improving calf and lower-limb muscle strength.
• Gradually increasing walking and other weight-bearing activities.
• Addressing movement patterns that may be placing excessive strain on the tendon.

However, the location of the tendon problem is particularly important.

For example, traditional heel-drop exercises performed over the edge of a step may be suitable for some people with midportion Achilles tendinopathy.

These exercises may aggravate insertional Achilles tendinopathy, because dropping the heel below the step increases compression around the tendon attachment.

An appropriately qualified physiotherapist can help determine which exercises are suitable and how quickly they should be progressed. [2][3]

3. Cold and Heat Therapy

During the first 48–72 hours following a new injury or acute flare-up, cold therapy may help manage discomfort and associated swelling.

Applying a cold pack wrapped in a towel for approximately 10–20 minutes at a time can provide temporary pain relief. Cold therapy may also be useful if the tendon becomes irritated again after activity.

Once the initial swelling and acute irritation have settled, gentle heat may help relieve stiffness and tightness in the surrounding calf muscles.

Warmth helps increase local blood circulation and may make movement more comfortable, although heat alone won't repair damaged tendon fibres.

Avoid applying heat directly over an area that remains noticeably hot, red or significantly swollen.

4. Footwear and Heel Support

Suitable footwear can help reduce unnecessary strain on the Achilles tendon during everyday activities.

Shoes with adequate cushioning and appropriate support may be beneficial, while a softer heel counter may help when discomfort is concentrated around the tendon attachment.

In certain cases, a temporary heel lift or suitable insole may be recommended to reduce mechanical stress.

However, the most appropriate footwear changes depend on whether the problem affects the middle of the tendon or its attachment to the heel bone.

5. Medication and Other Medical Treatments

Pain-relieving medication may sometimes be recommended to help manage discomfort.

Anti-inflammatory medication may be useful in certain situations, although persistent Achilles tendinopathy isn't always primarily caused by inflammation.

Corticosteroid injections directly into the Achilles tendon are generally avoided because of the risk of weakening the tendon and potentially contributing to rupture.

For persistent cases, other treatments such as extracorporeal shockwave therapy may be considered.

Surgery is rarely required and is generally reserved for selected cases that haven't responded to an appropriate course of conservative treatment. [2]

6. Managing Swelling and Associated Pain with OSMO Patch

If Achilles tendon discomfort is accompanied by swelling and associated pain, OSMO Patch offers a drug-free, non-invasive home treatment option designed to help reduce swelling and discomfort while you sleep.

Developed in Australia and trusted for over 15 years, OSMO Patch is applied externally over the affected area before going to bed, following the supplied instructions.

Unlike medications, it contains no drugs or steroids and doesn't involve injections or invasive procedures.

OSMO Patch may be considered alongside adequate rest, appropriate activity modification and rehabilitation.

However, persistent Achilles tendinopathy doesn't always involve significant swelling, and OSMO Patch isn't intended to repair damaged tendon fibres or replace the strengthening exercises often required for recovery.

Where Achilles pain is associated with medically diagnosed heel bursitis, OSMO Patch may also offer a practical option for helping manage the swelling and associated discomfort.

Looking for a drug-free, non-invasive option to help manage swelling and associated pain around your heel?

>> Discover OSMO Patch for Heel Bursitis Relief→

(ALWAYS FOLLOW THE DIRECTIONS FOR USE. Not suitable for individuals with seafood or shellfish allergies)

How Long Does Achilles Tendonitis Take to Heal?

Recovery times vary depending on which part of the Achilles tendon is affected, how long symptoms have been present and how well the tendon responds to appropriate rehabilitation.

Mild cases may begin improving within several weeks after reducing aggravating activities and receiving appropriate treatment. However, more persistent Achilles tendinopathy can take several months to improve, particularly when the tendon has been subjected to repeated strain over an extended period.

When swelling and associated pain are present, using OSMO Patch alongside adequate rest and avoiding activities that irritate the affected area may help support the recovery process.

However, it's important to remember that feeling less pain doesn't necessarily mean the tendon has fully recovered. Appropriate strengthening and a gradual return to normal activities are often necessary to restore the tendon's ability to tolerate physical strain.

Returning too quickly to strenuous exercise may aggravate symptoms and prolong recovery. [2][3]

 

Frequently Asked Questions About Achilles Tendonitis

Why Does My Achilles Hurt When I First Get Out of Bed?

Morning stiffness is a common symptom of Achilles tendinopathy.

After resting overnight, the affected tendon may feel uncomfortable when it is first placed under load. As you start walking, the stiffness may gradually ease, although the discomfort can return later after activity.

Persistent morning Achilles pain should be assessed to establish the underlying cause.

Is Achilles Tendonitis the Same as Achilles Tendinopathy?

Not exactly.

Achilles tendonitis refers specifically to inflammation of the tendon, whereas Achilles tendinopathy is a broader term used to describe tendon pain and dysfunction.

Longer-standing Achilles problems often involve changes within the tendon rather than inflammation alone, which is why tendinopathy is frequently the preferred medical term.

Can I Keep Walking if I Have Achilles Tendonitis?

In many cases, gentle walking may be appropriate, provided it doesn't significantly aggravate your symptoms.

However, longer distances, hills and repeated stair climbing may increase the load on the affected tendon.

You may need to temporarily reduce your walking distance and gradually increase activity as your symptoms improve.

A physiotherapist can help determine an appropriate level of activity based on your condition.

Should I Stretch My Achilles Tendon if It's Painful?

That depends on which part of the tendon is affected.

Certain stretching or heel-drop exercises may aggravate insertional Achilles tendinopathy by increasing compression around the tendon attachment.

Although appropriately selected rehabilitation exercises can be beneficial, aggressive stretching shouldn't be assumed to be helpful.

Exercises should be tailored to the specific condition and your current symptoms.

Can Achilles Tendonitis Cause Swelling Around My Heel?

Yes. Achilles tendinopathy can sometimes cause swelling or thickening along the tendon.

However, swelling around the back of the heel may also be associated with Achilles bursitis or retrocalcaneal bursitis.

Because these conditions can occur together, a proper diagnosis is important when swelling and pain persist.

Can Achilles Tendonitis Heal Without Surgery?

Yes. Most cases can be managed without surgery through appropriate activity modification, physiotherapy and gradual strengthening.

However, longer-standing tendon problems may require several months of rehabilitation, and progress is often gradual.

Surgery is generally considered only when symptoms remain troublesome despite an appropriate course of non-surgical treatment.

 

When Should You Seek Medical Attention?

If Achilles pain persists, worsens or begins interfering significantly with walking, sleeping or everyday activities, consult a qualified healthcare professional.

Seek urgent medical attention if you experience a sudden popping sensation, severe pain following an injury or difficulty pushing off your foot. These symptoms may indicate an Achilles tendon rupture.

Increasing redness, warmth or swelling accompanied by fever also requires prompt medical assessment.

An accurate diagnosis can help ensure that your treatment and rehabilitation are appropriate for the structures involved.

Medical References

[1] Healthdirect Australia: Achilles Tendon Injuries – Causes, Symptoms and Treatment. Read the Healthdirect medical guidance

[2] American Academy of Orthopaedic Surgeons (AAOS): Achilles Tendinitis – Symptoms, Diagnosis and Treatment. Read the AAOS medical reference

[3] American Physical Therapy Association – Academy of Orthopaedic Physical Therapy: Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision – 2024. Read the clinical practice guideline