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Achillodynia: Causes, Symptoms & Treatment

Achillodynia refers to pain in the area of the Achilles tendon. It is often caused by overuse and primarily affects athletes and physically active individuals.

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Things worth knowing about "Achillodynia"

Achillodynia refers to pain in the area of the Achilles tendon. It is often caused by overuse and primarily affects athletes and physically active individuals.

What is Achillodynia?

Achillodynia is a general term for pain conditions affecting the Achilles tendon, the strongest tendon in the human body. It connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). Pain in this region can involve the tendon itself or the surrounding tissue and is most commonly caused by overuse or mechanical overload.

Causes

Achillodynia is usually the result of several contributing factors:

Overuse: Intense or suddenly increased training, particularly running
Foot or leg malalignment: Flat feet, leg length discrepancy, or abnormal gait mechanics
Inadequate warm-up: Insufficient stretching of the calf muscles before exercise
Inappropriate footwear: Shoes that are too rigid or poorly fitting
Metabolic conditions: Such as gout, diabetes mellitus, or elevated cholesterol
Medications: Certain antibiotics (e.g. fluoroquinolones) can damage tendon tissue
Age-related changes: Reduced tendon elasticity with advancing age

Symptoms

The typical symptoms of achillodynia include:

Pain in the Achilles tendon region, most commonly 2–6 cm above the heel bone
Start-up pain: Pain at the beginning of movement that improves after a few steps
Pain after prolonged activity or in the evening
Morning stiffness and pain upon first standing after sleep
Swelling, warmth, or a palpable thickening of the tendon
Tenderness when pressing directly on the tendon

Diagnosis

Diagnosis is usually made through a clinical examination. The physician reviews the patient's complaints, exercise habits, and medical history. The following investigations may be used:

Ultrasound (sonography): To visualise changes, tears, or thickening of the tendon
MRI (Magnetic Resonance Imaging): For detailed assessment in unclear cases
X-ray: To rule out bony changes or calcifications
Laboratory tests: If metabolic or inflammatory conditions are suspected

Treatment

Conservative Treatment

Most cases of achillodynia respond well to conservative measures:

Load reduction: Temporary rest and adjustment of training volume
Eccentric strength training: Targeted training of the calf muscles, considered the most effective conservative method (Alfredson protocol)
Physiotherapy: Stretching, manual therapy, and gait retraining
Orthotics and insoles: Heel wedges or custom insoles to offload the tendon
Cooling: Local cold application to reduce pain and swelling
Pain relief medication: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for acute complaints
Shockwave therapy: Use of acoustic waves to promote tissue healing

Surgical Treatment

If conservative methods fail to provide relief after several months, surgical intervention may be considered. This typically involves removing degenerated tendon tissue or correcting structural causes.

Prevention

The following measures are recommended to prevent achillodynia:

Regular stretching of the calf muscles
Gradual increase in training intensity and volume
Appropriate, well-cushioned sports footwear
Strengthening exercises for the lower extremities
Adequate recovery time between intensive training sessions

References

Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clinics in Sports Medicine. 2003;22(4):675–692.
Alfredson H, Pietila T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. American Journal of Sports Medicine. 1998;26(3):360–366.
Kearney RS, Parsons N, Costa ML. Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-rich plasma injection with an eccentric loading programme. Bone and Joint Research. 2013;2(10):227–232.

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