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The Runner’s Guide to Achilles Tendonitis

by | March 2, 2020

Runners are at risk of several injuries, which can cause downtime. Despite the fact that the Achilles tendon is the largest and strongest tendon in the body, Achilles tendonitis is one challenge that affects a large number of runners every year.

Please realize that I know “tendinitis” is the proper way to spell it, but people do not spell it that way when they are searching for the topic. Same goes for “tendinopathy”.

What Is Achilles Tendonitis?

The Achilles tendon refers to the connective tissue that connects the rear region of the lower leg to the heel bone. Particularly, the connective tissue starts at the calf muscles. From here, it extends toward the heel bone. The connective tissue forms a band-like structure. Achilles tendonitis is an inflammatory condition that affects the Achilles tendon in its acute stage and becomes chronic and degenerative over time. Tendinopathy is technically the more appropriate wording but, I will use tendinitis since more people know this name. It can affect the mid-portion of the tendon or the insertion of the tendon on the heel bone.

The condition arises mostly in runners, but also affects participants in other sports and non-athletes as well. It affects approximately 9-11% of runners, whereas 52% of elite male distance runners will have it at some point during their life. It is primarily linked to an overuse of the Achilles tendinitis. This is due to the pressure that is placed upon the Achilles tendon in runners. The condition does seem to be much more common in athletes who are middle-aged, compared to those of a younger age. It is not only runners that need to be concerned about the condition. Some sports, such as basketball and tennis, have also been linked to a higher risk of Achilles tendonitis.

What Does Achilles Tendonitis Feel Like?

Symptoms associated with Achilles tendonitis tend to differ based on how severe the condition is. In most people, the symptoms start as mild pain. The pain will usually be at the back of the person’s leg. In some cases, pain may be experienced at the back of the heel – generally just above the heel bone’s location.

Some people tend to experience severe pain symptoms after specific physical activities. Prolonged running is known to cause a serious elevation of Achilles tendonitis symptoms. Other activities that can also make these symptoms severe include springing, jumping and climbing stairs.

Other symptoms can also accompany the pain that a person may experience with Achilles tendonitis. Tenderness is a common complaint. Some people may also find that the Achilles tendon is stiff when they suffer this condition. These symptoms will generally be at its worst when a person gets up in the morning. Mild activity may cause tenderness and stiffness to improve.

I am a runner and I was having some Achilles Tendinitis problems that were impacting my running. I had a podiatrist who didn’t want me to run, had me complete 2 MRIs and wear a boot with no resolution. I was feeling hopeless until Dr. Royer helped me with the Graston Technique. After some intense treatment I have been running regularly for quite a while now, with no pain, thanks to Dr. Royer. I would recommend him to anyone!

Melanie G. – Toledo, OH

Causes & Risk Factors for Achilles Tendonitis

Repetitive strain to the Achilles tendon is the primary cause behind this condition. It is also possible for Achilles tendonitis to develop when a significant amount of strain is placed on this particular tendon too quickly.

There are some factors that may increase a person’s risk of developing Achilles tendonitis. These are important to consider. Realizing the risk factors helps a person identify how likely they are to develop the condition themselves.

Age plays a role as those between 30 and 55 years have a higher risk of developing Achilles tendonitis. Obesity, reduced tendon flexibility/ankle-joint range of motion, reduced blood supply and a prior injury to the area are risk factors as well.

Other risk factors that may also play a role include:

  • Men seem to be more likely to suffer from Achilles tendonitis compared to women.
  • The use of inappropriate footwear can also be a risk factor.
  • People find that the symptoms of Achilles tendonitis seem to be greater among the winter months.
  • Some medications can cause an increased risk of the condition too. Medications to be taken into account here primarily include fluoroquinolones, which is a type of antibiotics.
  • People who prefer to run on terrains that are rougher or filled with hills may also be more likely to develop Achilles tendonitis.
  • Some medical conditions like high blood pressure, diabetes mellitus and rheumatoid arthritis can also act as risk factors. People with psoriasis also seems to be at a higher risk of Achilles tendonitis.

Will Achilles Tendonitis Heal by Itself?

It is possible for Achilles tendonitis to heal without the need for treatment from a medical professional. This, however, is only the case when the condition is very mild. It is always important to assess the situation and to carefully consider the symptoms that are being experienced.

Runners with more serious symptoms of Achilles tendonitis should consider seeking assistance from healthcare professional with training in sports medicine. This will help them assess the damage more accurately and get the right diagnosis. There are cases where severe damage occurred – in these situations, it is critical to obtain early treatment to prevent potential complications.

Treatment for achilles tendonitis

Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs like ibuprofen) and corticosteroid injections. Occasionally, patients are told to buy off-the-shelf arch supports and or they are prescribed custom orthotics. Sometimes, healthcare providers will prescribe walking boots for several weeks at a time. Surgery is often is the final suggestion. Unfortunately, none of these treatments have great support in the research and many people are left still being restricted from running.

  1. Squelch the fire
  2. Chiropractic Adjustment to the foot and ankle
  3. Kinesio Taping
  4. Graston Technique
  5. Rehabilitation of foot and ankle

It is important to squelch the fire because it is not going to heal if it is continually getting hurt. It is possible for most runners to continue training for a race if the clinician knows what they are doing. It would definitely get better faster if the runner took time off, but most runners do not even seriously consider that as an option. Decreasing inflammation can be helpful using OTC NSAIDs for some runners and most benefit from anti-inflammatory diets and supplementation. And Achilles tendinopathy patients are one of the few groups where heel lifts might be a good idea. This also means that zero drop running shoes are a no-no during recovery.

If needed, chiropractic manipulation to the foot and ankle to improve motion of the foot and ankle can be helpful. Kinesio Taping helps to control the fire and support the tendon but needs to be applied properly by a trained person. Graston Technique is an evidence-based treatment that quickly facilitates healing, improves ankle motion and improves ability of the tendon to bear weight using special stainless-steel instruments.

Resolution can also be brought about by using eccentric therapeutic exercises in combination with a stretching and strengthening program that addresses the biomechanics of the entire kinetic chain. This can include strengthening of the intrinsic muscles of the foot. These corrective exercises are invaluable for preventing Achilles tendonitis from recurring. 


Achilles tendonitis is a disabling condition that affects many runners. The condition can be painful and can lead to lost running time. Recognizing the symptoms is important and conservative treatment can effectively reduce symptoms and speed up the healing of Achilles tendonitis.


Article Featured in Toledo Roadrunners Club Footprints – Volume 46, Issue 3 (March 2019)

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