Symptoms

Symptoms of Achilles tendinopathy may include:

• Pain in the back of the heel, in the Achilles tendon area. Pain may be mild or severe, and swelling may occur.
• Tenderness in the Achilles tendon area. Tenderness may be more noticeable in the morning.
• Stiffness that goes away as the tendon warms up with use.
• Decreased strength and movement, or a feeling of sluggishness in the leg.

Symptoms of an Achilles tendon rupture may include:

• A sudden, sharp pain that feels like a direct hit to the Achilles tendon. There may be a pop when the rupture occurs. This may be followed by swelling and bruising.
• Heel pain (may be severe).
• Not being able to go on tiptoe with the hurt leg.

If you have a partial rupture (tear) of the Achilles tendon, you may have near-normal strength and less pain after the initial injury, compared to what you experience after a complete rupture.

What Happens

Achilles tendinopathy

Achilles tendinopathy starts with repeated small tears in the tendon, causing no obvious symptoms or mild to severe pain during movement. As the tearing continues, the leg may weaken and the tendon pain may become constant. Abnormal growths (nodules) may develop in the tendon. And it may thicken.

Resting and treating your injured Achilles tendon will likely reduce the pain. Stretching and exercising in physical therapy or a rehabilitation (rehab) program will restore flexibility and strength in your lower leg. Warming up the lower leg and Achilles tendon will help promote healing and keep the condition from getting worse as you resume more intense activities, such as sports or stair climbing.

Without rest and treatment of Achilles tendinopathy, you may develop long-lasting (chronic) pain.

Achilles tendon tear or rupture

An Achilles tendon can partially tear or completely tear (rupture). If your Achilles tendon has ruptured, your leg may be weak, and walking may be difficult.

A tear usually occurs in the tendon about 1.5 in. (3.8 cm) to 2.5 in. (6.4 cm) above its attachment to the heel bone. Some doctors believe that this area is most likely to tear or rupture because of a limited blood supply.

If you treat an Achilles rupture with:

• Surgery followed by a rehab program, you will likely regain full movement and function.
• A cast, brace, splint, walking boot, or other device that keeps your lower leg from moving (immobilization), the tendon will most likely heal but may not be as strong as before the injury and may be more likely to rupture again. Exercising, in physical therapy or in a rehab program, will help restore flexibility and strength in the lower leg.

If you do not treat an Achilles rupture, you will feel weakness in the first steps when walking, with a feeling similar to that of walking in the sand. Eventually, walking will become difficult.

Other Achilles tendon problems

Other conditions can affect the Achilles tendon area alone or along with tendinosis. These other conditions are caused by inflammation and include:

• Achilles paratenonitis, which is an inflammation of the covering of the Achilles tendon. Symptoms include tenderness, pain, and swelling in the Achilles area, all of which are usually worse during activity. This is also called Achilles peritendinitis.
• Retrocalcaneal bursitis, which is an inflammation of the small fluid-filled sac (bursa) between the back of the heel bone and the Achilles tendon, just above the point where the tendon connects to the bone. The inflammation causes swelling, tenderness, and pain on the back of the foot. See an illustration of the retrocalcaneal bursa.
• Insertional Achilles tendinopathy, which is damage in the area where the tendon attaches to the heel bone. Symptoms include tenderness on the lower back of the heel and less ability to overflex the foot. Pain tends to be worst after exercise and can eventually become constant. This condition often develops along with retrocalcaneal bursitis.