Achilles Tendon Pain: Causes, Symptoms, and Treatment

What causes Achilles tendon problems?

Especially in the spring, we regularly see patients with Achilles tendon problems.

These symptoms are usually caused by overuse (tendopathy) and often develop gradually. The trigger is almost always excessive exercise or too much strain. In chronic cases, the Achilles tendon may even rupture.

The Achilles tendon is the strongest tendon in the body. It transmits the force generated by the calf muscles to the foot and absorbs several times the body’s weight with every step. It consists of tissue that reacts rapidly to mechanical stress at the molecular and cellular levels. Anabolic and/or catabolic proteins can change significantly within hours during or after exercise and return to their baseline levels within 72 hours. 

When we run, forces acting on the Achilles tendon with every step can exceed ten times our body weight. These forces are even greater when jumping and hopping. Its exceptional tensile strength and thickness enable it to withstand the extreme stress to which it is subjected. The average length of the tendon is 20–25 cm, with muscle fibers inserting at the front almost all the way to the tendon’s origin.

Achilles tendon problems often develop gradually. Once they appear, however, they can be quite persistent and long-lasting. They most commonly affect physically active people, primarily men between the ages of 30 and 50.

Achilles Tendinopathy

Tendopathy is a painful irritation of the Achilles tendon or its attachment site (enthesis). This irritation often leads to a thickened, swollen Achilles tendon and tenderness when pressure is applied. The condition is usually caused by overuse resulting from an increased or excessive training load. Runners and recreational athletes who return to sports after a long break from training are often affected by Achilles tendinopathy. However, foot deformities such as a flat foot or high arch can also be responsible.

For athletes, the risk increases with age and the number of kilometers covered during training.

Sports that typically lead to overuse injuries include:

• Middle-Distance, Long-Distance, and Orienteering
• Track and Field
• Tennis
• Badminton
• Volleyball
• Soccer

Causes and Risk Factors

• shortened, tight, or fatigued calf muscles
• inadequate warm-up
• Increasing the training volume too quickly or training too hard
• Recovery periods that are too short
• Extreme physical exertion, such as speed runs and hill runs
• unsuitable shoes, such as those made of material that is too stiff or with a poorly placed heel counter
• Taking Quinolone Antibiotics
• muscle imbalance in the calf muscles
• Diabetes mellitus, arthritis, gout
• Overweight

Causes of Recurrent Achilles Tendon Pain

• Spinal Problems
• shortened hamstring
• Leg-length discrepancy
• Hip Misalignment

A gait analysis can help identify typical risk factors and symptoms and allow for appropriate measures to be taken.

Symptoms: When the Achilles tendon is swollen and painful

Initially, weight-bearing pain occurs in the heel, with the area approximately 2 to 3 cm from the Achilles tendon insertion typically being the site of the pain.

In acute tendopathy, overuse of the tendon leads to microtears in the tendon structure, similar to muscle soreness.

As a general rule, it takes six to eight weeks for an injured Achilles tendon to heal enough to bear weight again. If symptoms persist for more than two weeks, you should definitely have them checked by a doctor, because progressive damage to the tendon can lead to a tear in the Achilles tendon—or even a complete rupture.