5 min read
The Achilles is the thick cord you can feel at the back of your ankle, connecting the calf muscles to the heel bone. It is the largest tendon in the body and it takes a multiple of your body weight with every running stride. For years it does that without complaint. Then, often somewhere in the thirties or forties, it starts to be stiff in the morning or sore after a game, and the natural response is to stretch it a bit and carry on.
Why this shows up when it does
Tendons change with age. They gradually become less elastic and have a more limited blood supply than muscle, so they adapt to new demands slowly. Meanwhile, plenty of people in this age range are asking more of the tendon than they have in years: returning to running, joining a rec league, starting a training program, or simply packing a week of activity into Saturday.
Achilles trouble is typically an overuse problem rather than a single injury. It tends to follow a sudden increase in how much or how hard you are training, tight calf muscles, a change of footwear or surface, or hill work. It is also not limited to athletes. Jobs that involve long hours on hard floors or climbing in and out of equipment load the same tendon.
What it usually feels like
The pattern people describe is fairly consistent, though none of it is a diagnosis:
- Stiffness or aching at the back of the heel or just above it for the first steps in the morning, easing as you move.
- Soreness that comes on after activity, or the day after, rather than during it.
- Tenderness when the tendon is squeezed between finger and thumb.
- A thickened or lumpy section of the tendon, usually a few centimetres above the heel.
- Pain where the tendon meets the heel bone that is aggravated by the back of a shoe.
The reason not to just push through
Tendon pain has a misleading habit: it often eases once you are warmed up. That makes it easy to train through, and training through it is how a few sore weeks become a problem measured in seasons. A tendon that keeps being overloaded can thicken and change in structure, and the longer that has been going on, the more persistent it tends to be.
There is also a more serious end of the spectrum. The Achilles can tear, and medical sources place the peak age for that injury between 30 and 40, most often during recreational sport that involves sudden pushing off or changing direction, such as basketball, tennis or soccer. Most people with a sore Achilles never experience this. But it is the reason clinicians take long-standing Achilles pain in an active adult seriously rather than treating it as ordinary wear.
A tear is usually unmistakable. People describe a sudden pop or the sensation of being kicked in the back of the leg, followed by difficulty pushing off or standing on the toes of that foot. That is not something to watch for a few days; it needs prompt medical attention.
It is not always the Achilles
Pain at the back of the heel has several possible sources. A bony enlargement at the back of the heel bone, an irritated fluid sac between the tendon and the bone, a nerve, or a problem in the joint beneath the ankle can all produce it. In adolescents, pain at the back of the heel is more often related to the growth plate. They are managed differently, which is the practical reason for having it identified rather than assumed.
What an evaluation involves
An Achilles evaluation covers when the pain started, what your activity looks like, and what changed before it began. The examination looks at where exactly the tendon is tender, whether it is thickened, how flexible the calf and ankle are, and how the foot is aligned when you stand and walk. Imaging is sometimes used to look at the tendon itself or the heel bone.
From there, the options that fit your situation are discussed with you in person. They depend on which part of the tendon is involved and how long it has been going on.
Coming to us from outside Chillicothe
Bends Foot and Ankle has one office, at 37 N Plaza Blvd in Chillicothe, Ohio. Patients from the surrounding towns are seen there, and each of these pages covers the drive in:
- Circleville, Ohio: about 25 minutes · about 18 miles · US-23 south
- Waverly, Ohio: about 25 minutes · about 20 miles · US-23 north
- Frankfort, Ohio: about 15 minutes · about 14 miles · US-35 east
- Jackson, Ohio: about 35 to 40 minutes · about 33 miles · US-35 west
If the back of your heel has been stiff or sore for more than a couple of weeks, or it keeps returning every time you get active again, it is reasonable to have it examined before the next season rather than after it. Dr. Storts evaluates Achilles and heel problems at our office in Chillicothe.
This article is general information about a common foot and ankle condition. It is not medical advice and it is not a diagnosis of your own symptoms. If something is wrong with your foot, have it examined.
Care at Bends Foot and Ankle is provided by Eric Storts, DPM, FACFAS, board certified podiatric foot and ankle surgeon.