Achilles Tendon Pain: Finding The Cause

♻️ Last update: April 24, 2025.
👩‍⚖️ Declaration of financial interests: none directly related to the subject. My complete declaration of financial interests is in the legal notice section.
Written by Nelly Darbois, physiotherapist and scientific editor

Case 1: Achilles heel pain after a particular event

Does your Achilles tendon ache after exertion? It can happen after running, jumping or intense training.

1 in 4 athletes will suffer an Achilles tendon injury during their lifetime. This risk increases with age (Medina Pabón, 2023).

Sometimes, simply after walking a lot, or standing longer than usual.

Pain may appear suddenly or within a few hours :

• you feel discomfort when you wake up;
• the tendon is stiff and sensitive to touch;
• sometimes it squeaks when you move your foot.

This pain is often caused by a simple overload of activity, in relation to what your body can withstand. The tendon may become inflamed, slightly thickened (swollen, thickened), then return to normal with partial or total rest.

When this happens too often, we speak of tendinopathy of the achilles tendon (tendinitis in everyday language).

In more serious cases, a crack or partial or total rupture of the Achilles tendon may occur.

Warning signs :

• sharp pain at night or at rest;
• difficulty walking on tiptoe or even walking at all;
• sensation of a sharp blow ;
• loud snap heard when a particular movement is made.

The diagnosis of an Achilles tendon problem is most often made by clinical examination alone . Your doctor will order additional tests such as an X-ray or ultrasound only to rule out a possible fracture or rupture of the Achilles tendon (Medina Pabón, 2023).

These clinical, biological or imaging examinations can also help identify other potential causes of pain in this area of the body:

• retrocalcaneal bursitis;
• inflammation of Kager’s fat pad (pain on palpation on both sides of the ankle, in front of the Achilles tendon);
• posterior ankle impingement (Os Trigonum syndrome);
• fatigue fracture of the calcaneus;
• plantar fasciitis;
• Sever’s disease (in children aged around 8-11 years);
• Nerve compression or neuroma;
• calcific insertion tendinosis ;
• Erdheim-Chester disease (rare+++).

Note that many of these syndromes are in fact treated in the same way, according to the symptoms experienced rather than the name of the syndrome. But putting a precise name to what you have is often important for some people.

Case 2: Achilles tendon pain for no reason

Do you feel pain without straining? This pain may be due to progressive wear and tear of the tendon. The pain sets in slowly, without any triggering effort, sometimes due to repeated rubbing.

Chronic tendinopathy can occur in athletes or sedentary people. Over time, calcifications can form in the tendon.
These increase pain and stiffness.

But pain can also come from another disease. For example.

• Ankylosing spondylitis.
• Inflammatory arthritis. It attacks tendons and joints.
• Chronic inflammation (such as autoimmune disease).

These pathologies cause pain with no direct link to exertion. The tendon swells, becomes stiff and painful, even without moving.

Why can the Achilles tendon swell?

Your Achilles tendon may swell due to inflammation. When the tendon is overstretched or damaged, your body reacts by sending blood and cells to repair it.

This is called an inflammatory reaction.

The tendon swells because :

• the small vessels around the tendon dilate;
• fluids accumulate in tissues;
• repair cells arrive on site.

This swelling is a sign that the tendon is defending itself.

Swelling makes the tendon thicker, sometimes hot and painful to the touch.
It becomes stiff and less flexible.

When should I consult a doctor about a painful Achilles tendon?

Very often when surfing the Internet or reading magazines, you’ll come across articles that say something like “if in doubt or worried, it’s crucial to consult your doctor”.

My aim here is not to repeat this widely-read formula, even though I understand why many web copywriters use it.

For my part, I want to be as precise as possible in advising you on when to consult or not.

1. In the vast majority of cases, tolerable heel pain with no other symptoms does not require urgent medical attention.

You can simply raise the subject with your GP at a future visit scheduled for something else, if it still worries you at the time.

2. Other symptoms associated with this pain may, on the contrary, encourage you to consult your doctor.

These symptoms are :

• great difficulty in walking with your foot supported,
• or if walking is extremely painful, almost impossible.

How can you be sure it’s not something serious?

Although it’s often impressive and worrying, Achilles pain is often benign.

Benign doesn’t mean not annoying. But it does mean that it’s not a sign of a more serious underlying disease, in the majority of cases.

Try to rationalize the situation

These are cognitive biases that lead us to immediately think of serious conditions such as cancer when faced with less serious symptoms, such as unusual pain.

Because serious cases of illness, such as cancer, are often more publicized and discussed, they are more accessible mentally, which can lead us to consider them more likely.

What’s more, once we have an idea in mind, we tend to look for information that confirms it rather than information that contradicts it. If we’re worried about a serious condition, we might ignore evidence that suggests otherwise.

Ask other people for advice

If these explanations aren’t enough to reassure you, you can ask someone around you for advice. Tell them what you’re thinking, why you think you have something serious.

Confronting your thoughts with the thoughts of another person can help you gain perspective.

And, depending on the situation, decide whether or not to seek medical advice.

Can tendon pain go away on its own?

Yes, absolutely. As a physiotherapist, I have many examples of situations where achilles tendon pain passes on its own over time without any specific treatment.

For example, if you increase the frequency of your running outings during the summer months. When the pace is reduced, the pain may fade and then disappear.

So don’t give up hope: if you have achilles tendon pain, it can go away on its own in time.

Now, is there anything we can do to speed up the disappearance of ankle swelling, whatever the original cause?

What can be done to avoid or relieve pain?

Here are the easy things you can do to relieve pain:

• apply cold ;
• elevate your foot in relation to your heart (declive), for example by propping yourself up with cushions. This generally relieves pressure in the foot and heel;
• Identify activities that trigger or aggravate pain and review their dosage;
• test different pairs of shoes. Depending on the thickness of the heel and the shape of the shoe, especially around the tendon, this can make the pain more or less severe, especially if it rubs against the Achilles tendon;
• increase your training loads gradually. Don’t go from 5 km to 15 km all at once, or from one run a week to 4.

Your physiotherapist can help you set this up if you can’t do it on your own. He or she can also show you ideas forspecific exercises or stretches, although this is not always an interesting therapeutic approach.

Although it seems reasonable to think that too high a training load could cause these achilles tendon pains, no significant association between training load and the onset of Achilles tendinopathy has so far been demonstrated in runners (Chen 2024).

More rarely, in cases of chronic, incapacitating pain, injections of platelet-enriched plasma are sometimes suggested (effectiveness unproven) or surgical treatment , which involves around 7 months’ convalescence before resuming activities (Medina Pabón, 2023).

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That’s all I wanted to say on the subject! Any questions or comments? See you in comments!