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Achilles Tendonitis: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment

What is Achilles Tendon?

Achilles tendon, also called the calcaneal tendon, is referred to as a tough band composed of fibrous tissue that runs at the back of the lower half of the calf. This tendon connects the muscles of the calf to the heel bone, called the calcaneus. These muscles include gastrocnemius and soleus muscles. Fluid-filled pockets or bursae are structures that provide lubrication to the Achilles tendon and prevent friction between the tendon, muscle, bone, and skin surfaces. This tendon is the largest and most powerful tendon of the human body and takes part in lifting the heel of the foot as the calf muscles contract, such as during walking. The tendon is commonly used during routine activities including walking, climbing stairs, jumping, running, and standing on tiptoes – any activities that involve lifting the feet off the ground. [1] 

What is Achilles Tendonitis?

Achilles tendonitis is characterized by the inflammation of the fibrous cord that connects calf muscles with the heel bone of the foot, Achilles tendon. As the inflammation occurs, the tendon develops tenderness and dull pain occurs as the person walks or performs other movements involving the Achilles tendon. The inflammation is a result of overuse injury of the tendon that usually occurs in runners, tennis, and basketball players. [2] 

Symptoms of Achilles Tendonitis 

The clinical features of Achilles tendonitis include:

  1. Pain above the heel and the posterior part of the leg as Achilles tendon and calf muscles are affected 
  2. Overuse injury leads to inflammation of the tendon. The tendon becomes thick due to the buildup of scar tissue 
  3. Ankle stiffness while walking and carrying weight 
  4. Pain when performing activities governed by the calf muscles. These include running, climbing, jumping, and standing on tiptoes. 
  5. Ankle tenderness in the morning and after periods of rest. This is due to the lesser production of lubricating fluid to facilitate the movement of the Achilles tendon. [3]

Causes and Risk Factors of Achilles Tendonitis 

The causes and predisposing factors of Achilles tendonitis are as follows:

  1. Male gender 
  2. Athletes or occupational workers who overuse their Achilles tendon have a higher risk of developing Achilles tendonitis. This includes running, jumping, tennis, basketball, football, and players from other sports categories.
  3. Performing the above-mentioned activities can increase the risk of Achilles tendonitis further if performed in worn-out or inappropriate shoes. Lack of physical support makes the Achilles tendon prone to injury and inflammation. 
  4. Tight calf muscles occur as a result of long-term use of heels among women. The calf muscles become taut and exert greater pressure on the Achilles tendon increasing the chances of tendon injury and inflammation. 
  5. A bone spur or abnormal bone projection 
  6. Individuals who suffer from psoriasis, hypertension, and other health conditions are more susceptible to Achilles tendonitis 
  7. Certain medications, such as a fluoroquinolone, anabolic steroids, and corticosteroids, also predispose an individual for developing Achilles tendonitis. [4]

Normal Healing Cycle

Before the discussion about the appropriate treatment options for Achilles tendonitis, a brief discussion of the normal healing cycle is required. The healing cycle comprises inflammation, proliferation, and maturation stage. If an individual is suffering from chronic Achilles tendonitis, the injured area of the tendon oscillates between the inflammation and proliferation stages and does not resolve. The description of each stage of the normal healing cycle is given as follows:

The first stage is the inflammation stage. The cardinal signs of inflammation include:

  1. Redness (increased blood flow due to vasodilation)
  2. Pain (the inflammatory mediators sensitize the pain nerve endings or nociceptors)
  3. Swelling (as the blood flow increases, fluid exudes out of the capillaries and accumulates in the tissue spaces)
  4. Warmth (as the blood flow increases, the temperature of the involved area also increases)
  5. Loss of function (an inflamed tendon is less likely to perform the function effectively than a healthy tendon)

During this stage, the inflammatory response causes the immune response to activate, which eliminates the disease-causing pathogen. This phase of the healing cycle renders a clean wound site.

The second stage, the proliferation stage, refers to the formation of scar tissue that fills the wound defect. During this stage, collagen fibers are laid down by the proliferating fibroblasts, new blood vessels form, along with the production of extracellular matrix and granulation tissue. While scar tissue is important for healing the Achilles tendon, excess scar tissue causes the tendon to become thick and short. The fibrous scar tissue also leads to the formation of myofascial trigger points as well as fascial restrictions that further limit the movement. Fascia is composed of superficial and deep layers. The deep fascia layer is made of aponeurosis, epimysium, perimysium, and endomysium in a superficial to deep sequence. 

The last stage, the maturation stage, refers to the resolution of the healing cycle and formation of a wound. This stage is crucial for healing as it indicates that the disease-causing pathogen is eliminated and the products of inflammation and proliferation stages are also removed. Thus, there remains no further threat to the relevant structure, in this case, the Achilles tendon. [5] 

Treatments That Are Not Effective For Achilles Tendonitis 

Following home remedies are widely used for treating pain and inflammation, however, these only provide short-term pain relief. Moreover, massaging and stretching may worsen the tendon injury; aggravate the inflammation process, and result in the formation of excess scar tissue. Common at-home treatments are:

  1. Heat and ice application
  2. Electric stimulation 
  3. Foam roller
  4. Massage 
  5. Joint mobilization or manipulation
  6. Stretching
  7. Strength exercises during the inflammation stage 

Effective Treatment Options for Achilles Tendonitis 

  1. Maintain a proper foot posture and refrain from excessive supination or pronation of the foot.
  2. Take adequate rest if the inflammation is acute or less severe. Inhibit repetitive movements that involve calf muscles and Achilles tendon. 
  3. Wear proper and appropriate shoes according to the relevant activity.
  4. Resolution of Inflammation Stage
    1. Adequate rest is beneficial for mild inflammation.
    2. MagnaHeal is a device made of neodymium, a rare earth magnet, which is further coated by anti-inflammatory substances. This device uses a magnetic field to reduce inflammation and pain. MagnaHeal 1 has a magnetic force length of 2 inches which is used for acute inflammation. Whereas, MagnaHeal 2 has a greater magnetic force length of 3 inches. It is commonly used for severe chronic inflammation and provides deeper stimulation. [6] 
    3. Achilles tendonitis patients may get relief from consuming an anti-inflammatory diet. This diet is beneficial for reducing internal inflammation and alleviating pain. The diet contains fruits, legumes, herbs, spices, PUFA (polyunsaturated fatty acids), and MUFA (monounsaturated fatty acids). [7]
  5. Resolution of the Proliferation Stage
    1. A1 Tool is used for releasing superficial and aponeurotic fascia restrictions.
    2. A3 Tool is used for releasing superficial muscle trigger points and scar tissue.
    3. A5 Tool is used for releasing deeper muscle trigger points, scar tissue, epimysium, perimysium, and endomysium fascia restrictions.

Achilles tendonitis is a common ailment among athletes owing to an overuse injury of the Achilles tendon. This condition impairs movement and hinders the routine activities of a person. Achilles tendonitis may be caused by anatomic anomalies, improper footwear, medications, and underlying health conditions. Effective treatment options such as consuming an anti-inflammatory diet, magnetic therapy, and the use of A1, A3, and A5 Tools for releasing fascia restrictions, scar tissue, and trigger points.   


  1. Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Dönmez G, Maffulli N. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010 May;18(5):638-43. doi: 10.1007/s00167-010-1083-7. Epub 2010 Feb 25. PMID: 20182867.
  2. Medina Pabón MA, Naqvi U. Achilles Tendonitis. [Updated 2021 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  3. Medina Pabón MA, Naqvi U. Achilles Tendonitis. [Updated 2021 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:
  4. Li HY, Hua YH. Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Res Int. 2016;2016:6492597. doi: 10.1155/2016/6492597. Epub 2016 Nov 3. PMID: 27885357; PMCID: PMC5112330.
  5. Guo S, Dipietro LA. Factors affecting wound healing. J Dent Res. 2010 Mar;89(3):219-29. doi: 10.1177/0022034509359125. Epub 2010 Feb 5. PMID: 20139336; PMCID: PMC2903966.
  6. Arabloo J, Hamouzadeh P, Eftekharizadeh F, Mobinizadeh M, Olyaeemanesh A, Nejati M, Doaee S. Health technology assessment of magnet therapy for relieving pain. Med J Islam Repub Iran. 2017 Jun 11;31:31. doi: 10.18869/mjiri.31.31. PMID: 29445660; PMCID: PMC5804424.
  7. Dragan S, Șerban MC, Damian G, Buleu F, Valcovici M, Christodorescu R. Dietary Patterns and Interventions to Alleviate Chronic Pain. Nutrients. 2020 Aug 19;12(9):2510. doi: 10.3390/nu12092510. PMID: 32825189; PMCID: PMC7551034.

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