The Guide to Heel Pain

The Guide to Heel Pain

Achilles Tendinopathy

Written by: Tourage Rafeei, PhD, DPT, OCS, Cert. DN

Tendons are bands of fibrous tissues that attach muscle to bone. The Achilles tendon is one of the largest tendons in our body and is one of the most commonly injured areas. It is a continuation of gastrocnemius and soleus muscles (calf muscles) that distally attaches to your heel bone (calcaneus). Achilles Tendinopathy is a blanket term that may also be referred to as Tendonitis, Tendinitis, Tendinosis, or Tenosynovitis by healthcare providers. The difference in terminology stems from the exact pathology that is causing your heel pain. Let’s take a look at some information regarding this common injury.

Causes of Achilles Tendinopathy

Tendinopathy can result from several different etiologies. Many people, including young athletes, middle aged weekend warriors, and even older people suffer from disorders of the Achilles tendon. Tendinopathy is related primarily to overuse of the tendon (repeated jumping, excessive walking/running, or similar activities). This excessive and repetitive stress may cause microtrauma and adhesion/scar tissues to build up inside the tendon. Ultimately, this damage will multiply over time and cause pain and dysfunction. Obviously, if the person continues to apply load to the tendon, it may end up rupturing the tendon. Direct blows to the tendon, although not common, can also cause injury to the Achilles tendon. Aging can also make you more susceptible to tendinopathy, as your tendons lose elasticity and water content, making them more prone to irritation and injury. The Achilles tendon has poor blood supply or cell activity, this type of injury can heal very slowly. Tightness of the calf muscles has also been known to contribute to the onset of Achilles Tendinopathy.

Symptoms of Tendinopathy

Tendinopathy results in pain and tenderness with deep palpation, with occasional swelling in the tendon. The most common time to feel this heel pain is during normal or strenuous walking, going up and down stairs, or any activity that requires heavy use of your lower legs. In severe cases, you may feel sharp pain, heat, redness, swelling and other signs of inflammation at the site of the injury.


One of the most effective ways to prevent Achilles tendinopathy is regular stretching exercises. These stretching exercises help prevent the formation of pain causing adhesions and scar tissue build up in the tendon. Additionally, having good footwear and solid support is extremely important, as worn and poorly fitting shoes may increase your risk for developing tendon irritation and repetitive microtrauma. Proper training techniques are also extremely important to minimize unwanted stress to the tendon. Avoiding excessive load on the tendon (overtraining or stress beyond the tendon’s capability for loading) is another crucial way to prevent damage and pain.

Physical Therapy for Achilles Tendinopathy

First line treatment for ankle pain may include medication, ice (and other modalities), rest and use of an ankle brace. However, Achilles pain and dysfunction, especially chronic condition, suggest a mechanical dysfunction of your ankle that needs to be treated carefully and thoroughly. Seeking a professional as soon as possible is extremely important, because excessive stress can lead to partial or complete rupture of the tendon. Your physical therapist will use a combination of manual therapy, specifically designed therapeutic exercises, and certain modalities (as needed), in order to address the disorganized tissue adhesions and improve the tendons ability to withstand normal tensile forces. Our goal is to work with you to reduce your heel pain, to get you back to your favorite activities, and to prevent future injury to the tendon.


We offer a free 15 minutes functional screening to evaluate your condition. 

Please call us to schedule an appointment for your free screening and to discuss any treatment that you may need.