Achilles tendinitis usually takes at least THREE months to settle, and some people need six months to a year. That feels slow, but it’s normal for a tendon.
The treatment with the best track record is a calf-strengthening program done most days for about 12 weeks. Rest alone makes the pain quieter for a while, then it comes back the moment you get busy again.
A little pain during the exercises is allowed. What matters is how the tendon feels the NEXT morning.
Symptoms
- Morning stiffness: the back of the heel is stiff and sore for the first steps of the day, then warms up
- Pain at the start of exercise: it often eases during a run, then hurts more afterward and the next day
- Tenderness or a thickened lump in the tendon a few inches above the heel, or right where it joins the heel bone
- Creaking or tightness when you move the ankle
Tendinitis or tendinopathy?
“Tendinitis” means an inflamed tendon. In most long-running cases the tendon isn’t very inflamed. It’s overloaded and has changed its structure, so clinicians call it tendinopathy. That matters because it explains why anti-inflammatory tablets and rest help so little. The tendon needs to be made stronger, not calmed down.
- Common triggers: a sudden rise in running, hills or jumping, a new sport, a change of shoes, or a busy spell on your feet
- More likely if: you’re middle-aged, have tight or weak calves, or carry extra weight
The exercises
There are two well-tested ways to load the tendon. Both work. Pick the one you’ll actually do.
- Heel drops (the classic program): stand on a step on the sore leg, rise up using both legs, then lower slowly on the sore leg until the heel dips below the step. Do 3 sets of 15, with the knee straight and again with the knee slightly bent, twice a day, for 12 weeks
- Heavy slow heel raises: slow heel raises up and down, about three seconds each way, with enough weight (a backpack or holding a weight) that the last few reps are hard. Fewer reps, about three times a week, adding load as you get stronger
- Start where you are: if heel raises hurt too much, begin with holds. Rise onto your toes on both feet and hold for 30 to 45 seconds, a few times
- Add load over time: once the exercises are easy, a heavier backpack keeps the tendon adapting
- Last comes spring: skipping, hopping and running come back once strength is good and mornings are calm
If the pain is right at the heel bone, don’t drop the heel below the step. Do the exercise on flat ground instead, which squeezes that spot less.
A sore tendon doesn’t need rest. It needs the right amount of load.
Pain rules
- During exercise: pain up to about 3 to 5 out of 10 is acceptable. Pick the lower number if you’re nervous
- The next morning: the real test. If it’s no worse than usual, carry on or add a little load
- If it’s worse the next day: ease back the reps, weight or running for a few days. Don’t stop completely
- Expect ups and downs: a bad week doesn’t mean the program has failed. Track what you can do, not only how it feels
Why avoid a steroid injection into the tendon
A cortisone injection INTO the Achilles weakens the tendon and can make it tear. The American Academy of Orthopaedic Surgeons says cortisone injections into the Achilles tendon are not recommended. If someone offers one, ask exactly where it’s going and why. See cortisone shot side effects.
What else helps
- A small heel lift in both shoes takes some strain off the tendon early on
- Keep moving: cycling and swimming usually keep you fit without flaring it
- Change running gradually: fewer hills and speed sessions for now, then add them back one at a time
- Shockwave therapy is sometimes added when months of exercise haven’t worked. It’s an extra, not a replacement for the exercises
- Surgery is rare, and only after at least six months of proper rehab
Pain under the heel rather than behind it is more likely the arch. See plantar fasciitis.
Get seen today if
- You felt a sudden kick or heard a pop at the back of the ankle
- You can’t rise onto your toes on that leg, or you’re walking flat-footed
- There’s a gap you can feel in the tendon
These point to a rupture, which needs treatment within days. See Achilles tendon rupture recovery.
Get it checked if
- Pain started soon after an antibiotic from the “floxacin” family, such as ciprofloxacin. Tell the prescriber
- The tendon is red, hot and very swollen
- Both Achilles hurt along with other swollen joints
- There’s no progress after three months of doing the exercises properly
Rest makes the tendon quieter. Loading makes it stronger.