Walker reaching down to touch a sore Achilles tendon at the back of the ankle

Achilles Tendon Pain: Home Treatment, Heel Lifts and Exercises That Help

Short answer: Achilles tendinitis is irritation of the large tendon that joins your calf muscles to your heel bone, usually from doing more walking, running or stair climbing than the tendon was ready for. The American Academy of Orthopaedic Surgeons recommends non-surgical treatment first: rest from high-impact activity, ice, calf stretching, eccentric strengthening (slow heel drops), supportive shoes and heel lifts. Be patient. Even with early treatment, the AAOS notes that pain may last longer than three months. A sudden snap or pop at the back of the ankle with sharp pain is a possible rupture and needs same-day medical attention.

What does Achilles tendinitis feel like?

  • Pain and stiffness along the tendon or at the back of the heel, worst with the first steps in the morning.
  • Pain that increases with activity and is worse the day after exercise.
  • Thickening of the tendon, or a tender lump a couple of inches above the heel.
  • Swelling that builds through the day.
  • Sometimes a bony bump at the back of the heel that rubs on shoes.

What causes it?

  • A sudden increase in exercise amount or intensity, including hills and stairs.
  • Tight calf muscles.
  • Worn or unsupportive shoes, or a switch to very flat shoes.
  • Age: the tendon becomes less elastic from middle age onward.
  • Flat feet, which increase strain on the tendon.
  • Certain antibiotics (fluoroquinolones) are associated with tendon problems. Tell your doctor if pain began during a course.

How do I treat Achilles pain at home?

  • Relative rest. Pause running and jumping. Switch to cycling, swimming or an elliptical trainer to stay fit.
  • Ice for up to 20 minutes after activity and whenever it is sore. See heat or ice for pain.
  • Heel lifts. A small lift or silicone heel cup in both shoes slightly shortens the distance the tendon has to stretch, reducing strain with every step. Useful in the painful early weeks.
  • Supportive shoes with a cushioned heel and a slight heel-to-toe drop. Avoid walking barefoot or in flat sandals for now. If shoes rub a bump at the back of the heel, choose a soft or open heel counter.
  • Compression ankle sleeve. Provides warmth and support and can reduce swelling. See our ankle supports.
  • Night splint. If morning pain is severe, a splint that keeps the foot at 90 degrees overnight stops the tendon tightening, the same principle used for plantar fasciitis.

Which exercises help the Achilles tendon heal?

  • Calf stretch. Lean into a wall with the sore leg behind, knee straight and heel down. Hold 30 seconds. Repeat with the back knee slightly bent. Several times a day.
  • Eccentric heel drops. This is the best-supported exercise for the mid-tendon form. Stand on the edge of a step holding a rail. Rise onto both toes, shift your weight to the sore leg, then lower the heel slowly below step level over about three seconds. Use both legs to rise again. Build gradually toward three sets of 15, once or twice a day. Mild discomfort is expected. Sharp pain means reduce the range or do it on flat ground.

If your pain is right at the heel bone rather than higher up the tendon, do heel drops on flat ground only, without letting the heel drop below the step. A physical therapist can tailor the programme.

When should I see a doctor?

Seek same-day care if you felt or heard a pop at the back of the ankle, have sudden sharp pain as if kicked in the calf, or cannot rise onto your toes or push off when walking. These suggest a tendon rupture.

See a doctor if pain has not improved after several weeks of home treatment, if the tendon is significantly swollen or thickened, or if pain began while taking an antibiotic.

Key takeaways

  • Achilles tendinitis is an overuse injury that heals slowly, often over three months or more.
  • Reduce impact, ice after activity and wear supportive shoes with heel lifts in both shoes.
  • Calf stretches and slow heel-drop exercises are the core of recovery.
  • A compression sleeve or night splint can help with swelling and morning stiffness.
  • A sudden pop with sharp pain is an emergency.

Sources

This article is general wellness information and is not medical advice. It does not replace an examination by a qualified healthcare professional. If your pain is severe, sudden or getting worse, please see a doctor.

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