Do you experience point tenderness in the back of your lower leg or around your Achilles? Does this pain prevent you from running, dancing, or even just walking? Do you try to push through the discomfort, only to find that the pain forces you to stop?

This could be a sign of Achilles tendonitis, a condition that should not be ignored. The Achilles tendon is the strongest tendon in the body, connecting the calf muscle to the heel bone. It’s essential for movements like standing on your toes, running, jumping, or dancing—and even simple activities like walking can become uncomfortable when it’s irritated.

The Achilles tendon has reduced blood flow (vascularity) as it nears the heel, particularly about 5–6 cm above it. Because of this limited blood flow, injuries in this area are slow to heal. Continuing activities that cause pain can keep the tendon in a constant state of inflammation, preventing proper recovery. Over time, this chronic inflammation can cause the tissue to become diseased, making it harder to treat. If ignored for too long, it could eventually lead to an Achilles rupture.

Causes

Achilles tendonitis can be caused by both intrinsic (body-related) and extrinsic (environmental) factors.

Intrinsic factors:

• The alignment of your knees, which influences the position of your feet. If you're "knock-kneed" or "bow-legged," your feet may compensate to correct the knee positioning, putting extra stress on the Achilles tendon, which can lead to irritation and inflammation.
• High or low arches can also contribute to Achilles tendonitis.
• Limited or excessive ankle dorsiflexion (the motion that allows you to pull your foot upwards) can place stress on the Achilles tendon during movement.
• Weakness in the muscles that help you rise onto your toes or control the descent can also lead to stress on the Achilles.

Extrinsic factors:

• Training errors, such as doing too much too soon
• Overuse or repetitive activity
• Poor footwear
• The type of surface you play or train on
• Inadequate recovery time
• Training routines that focus on one side of the body

Treatment

Finding the root cause of your Achilles tendonitis is essential for effective treatment. Is it related to the alignment of your knees or feet? Or could it be due to improper training, footwear, or running surface?

Early treatment and identifying the main cause are key to a quicker recovery. Techniques such as inflammation-reducing modalities, stretches to improve ankle mobility, and eccentric strengthening exercises have all been shown to help. However, treatment isn’t always as straightforward as it might seem. Depending on the specific location of the pain, some methods may not work as effectively. Managing Achilles tendonitis on your own is not advised. Seeking care from a physical therapist or healthcare provider is essential to ensure proper treatment, prevent delayed healing, and avoid potential complications.

If you think you have Achilles tendonitis or have had pain in your Achilles for longer than 6 weeks, click the link and schedule a visit with one of our foot and ankle specialists to see if physical therapy will work for you.