Achilles Tendinitis and Achilles Tendinosis: symptoms, causes and treatments

Updated 12/17/2018
Dr. Baravarian discuss the difference between Achilles Tendonitis, tendonosis and a rupture.

The Achilles tendon is one of the longest tendons in your body, extending from your calf muscles to the bones of your heel. It allows you to extend your foot and point your toes to the floor. Unfortunately, it's one of the most frequently injured tendons.


Inflammation of the tendon, known as Achilles tendinitis, is a common sports injury and most cases can be treated at home under the care of your physician.


More advanced cases of Achilles tendinitis can lead tendon tears that require surgery.

Symptoms of Achilles Tendinitis

Achilles Tendinosis, Achilles Tendinitis, University Foot and Anke Institute
UFAI's Dr. Baravarian discusses chronic Achilles tendon injuries in Podiatry Today.

Patients often report a mild ache in the lower region of the calf or above the heel after activity. There may be tenderness or stiffness after rest or the tendon may be swollen, painful to touch and standing on your toes may be difficult. It may be painful to "push off" while walking.


Hearing a snapping or popping noise during the injury or have a hard time flexing your foot or pointing your toes is something you never want to ignore. These indicate a possible complete Achilles tendon rupture and you will want to contact your healthcare provider immediately. Read more about Achilles tendon tears and ruptures here.


If you symptoms also include redness and a bony bump along the back of the heel bone, you may have an Achilles heel spur.



Causes of Achilles Tendinitis

  • Sudden increase in the intensity of activity
  • Tight calf muscles
  • Running too often or running on hard surface
  • Sudden increase it the distance of running or walking
  • Jumping a lot (as ones does in basketball)
  • Wearing shoes without proper support
  • No warm-up or stretching prior to physical activity



Achilles Tendinitis vs. Tendinosis

Achilles tendinosis is very similar to tendinitis with one critical difference: it has now become a “chronic” condition, usually because the injury wasn’t properly treated early on. The condition is now degenerative and the tendon is thickened with scar tissue and partial tearing of the tendon fibers may occur.


At this point, without medical intervention, the pain is going to remain or get worse over time.



Diagnosing an Achilles Injury

During the physical exam your doctor will examine your lower leg and back of the ankle for pain and inflammation. You may be asked to stand on the balls of your feet so they can see range of motion and flexibility.


Your doctor can observe the integrity of your tendon by squeezing the calf muscle while you are lying on your stomach on the exam table. If a rupture or tear is suspected, an MRI may be ordered.



Conservative Treatments For Achilles Tendinitis

Luckily most Achilles injuries are highly treatable thanks to modern medicine, but more difficult to treat once the condition becomes chronic. This is why seeing a doctor early is the smartest approach to Achilles injuries. Conservative treatment options include:

  • Orthotics
  • Stretching
  • Physical therapy and strengthening exercises
  • Decreasing activities hat stresses the tendon
  • Brace or walking boot to immobilize the tendon during the healing
  • Nonsteroidal anti-inflammatory drugs can reduce inflammation and provide pain relief


Advanced Non-invasive Treatments For Achilles Tendinosis

Platelet Rich Plasma (PRP)

In this treatment the patient’s own platelet-rich plasma is injected into the affected tendon. The growth factors in the platelets spur healing and recovery.

Stem Cell Therapy

Patients’ own stem cells are injected into the damaged region of the Achilles where they quickly begin to multiply. These regenerative stem cells are responsible for regenerating and rebuilding the body. This treatment is well tolerated and virtually pain-free.



The Topaz Procedure is a minimally invasive procedure that is done in the operating room. Small holes are made in the tendon to stimulate the body to send growth factors to help heal the tendon and to reduce scar tissue.



Tenex uses ultrasonic energy that targets scarred and damaged tissue and breaks it down without disturbing the surrounding healthy tissue.


Shockwave Therapy

This non-invasive procedure delivers small, controlled, low-energy shockwaves that cause micro trauma to the damaged tissue. This initiates the healing response, allowing new blood vessels to form in the area and signals more growth factors and nutrients to the area.



This non-invasive procedure uses radiofrequency technology to safely heat and warm the tendon. This deep healing of the tendon stimulates the body to send growth and healing factors to the treatment area. Patients are in a boot for 2-3 weeks following the procedure.


Achilles Tendinosis and Achilles Tendonosis: causes, symptoms and treatments

Surgery for Achilles Tendon Repair

Occasionally, damage to the Achilles is so severe it doesn’t respond to any non-surgical treatment options. In these rare cases, Achilles surgery is be needed to remove scar tissue and repair the tendon allowing the it to heal properly.


This surgery involves examining the Achilles tendon intra-operatively and removing any damaged or scarred tissue that is present. This procedure may leave a defect in the Achilles that may weaken the tendon. A graft can be used to augment the repair of this tendon should the scarred lesion be big.


This surgery requires extensive rehabilitation and patients will need to be immobilized in a cast for at 4-12 weeks depending on the extent of scar tissue that was removed.

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