Can I keep running with Achilles tendinitis?

Running through sharp pain is not advisable, as it can turn a treatable tendinopathy into a rupture. Mild soreness that eases as you warm up and does not worsen the next day may be acceptable at reduced volume, but it is safer to switch to low-impact exercise while you do the strengthening program, then return gradually.

How long does Achilles tendinitis take to heal?

Tendons heal slowly because they have a limited blood supply. Mild cases may settle in a few weeks, while chronic tendinopathy often takes 3 to 6 months of consistent eccentric exercises to improve. Patience and sticking with the program matter more than any single treatment.

Are cortisone injections a good idea for the Achilles?

Steroid injections into or around the Achilles tendon are generally avoided because they can weaken the tendon and raise the risk of rupture. Most specialists prefer rehabilitation exercises, load management, and in resistant cases shockwave therapy.

MusculoskeletalICD-10: M76.6Common, especially among runners and recreational athletes

Achilles Tendinitis

Also known as: Achilles tendinopathy, Achilles tendonitis

Achilles tendinitis is an overuse injury of the Achilles tendon, the thick band of tissue that connects your calf muscles to your heel bone. It causes pain and stiffness at the back of the ankle or heel, typically worse first thing in the morning or at the start of exercise. It is common in runners who suddenly increase their mileage or intensity, and in middle-aged people who play sport only occasionally. The condition can affect the middle of the tendon or the point where it attaches to the heel. Most cases respond well to rest, specific strengthening exercises and footwear changes, but ignoring the pain increases the risk of a complete tendon rupture.

At a Glance

Common symptoms: Pain and stiffness along the back of the heel or lower calf, worst in the morning, Pain that eases with gentle movement but worsens after exercise or at the end of the day, Tenderness or warmth when the tendon is squeezed
Main treatments: Relative rest: reduce or swap high-impact activity for swimming or cycling until pain settles, Ice and short-term anti-inflammatory medication for pain and swelling, Eccentric calf-strengthening exercises (slow heel drops), the best-supported treatment for tendon recovery, ideally guided by a physiotherapist
Category: Musculoskeletal · Common, especially among runners and recreational athletes
See a doctor if: A sudden snap or pop at the back of the ankle followed by weakness or inability to push off the foot (possible rupture; seek urgent care)

Symptoms

Pain and stiffness along the back of the heel or lower calf, worst in the morning

Pain that eases with gentle movement but worsens after exercise or at the end of the day

Tenderness or warmth when the tendon is squeezed

Thickening or a lump along the tendon

Swelling that gets worse with activity

Limited ability to flex the foot or rise onto the toes

Creaking sensation when moving the ankle

Causes

Repetitive strain from running, jumping or sudden increases in training volume or intensity
Tight or weak calf muscles that transfer extra load to the tendon
Running on hills or hard surfaces
Worn-out or unsupportive shoes, or a sudden switch to flat or minimalist footwear
A bone spur at the heel rubbing on the tendon (insertional tendinitis)
Reduced blood supply and flexibility in the tendon with age

Risk Factors

Being male and middle-aged
Flat feet or over-pronation
Obesity, which increases load on the tendon
Fluoroquinolone antibiotics, which are associated with tendon problems
Diabetes, high blood pressure and psoriasis
Training errors such as skipping warm-ups or ramping up quickly after time off

Diagnosis

Physical examination of the tendon for tenderness, swelling, thickening and strength
Assessment of calf flexibility, foot alignment and footwear
Ultrasound to assess tendon thickening and small tears
MRI if rupture is suspected or symptoms do not improve with treatment

Treatment

Relative rest: reduce or swap high-impact activity for swimming or cycling until pain settles
Ice and short-term anti-inflammatory medication for pain and swelling
Eccentric calf-strengthening exercises (slow heel drops), the best-supported treatment for tendon recovery, ideally guided by a physiotherapist
Heel lifts or supportive footwear to reduce strain on the tendon
Shockwave therapy for stubborn cases
Surgery only for tendons that fail to improve after 6 months of proper rehabilitation, or for rupture
Supportive: maintaining a healthy weight and gradual return to running reduce reinjury

Prevention

Increase training distance and intensity gradually, by no more than about 10 percent a week
Stretch and strengthen the calves regularly
Warm up before exercise and cool down afterwards
Replace running shoes before they wear out and avoid abrupt changes in shoe type
Cross-train with low-impact activities to give the tendon rest days
Avoid running on hard or uneven surfaces when possible

When to See a Doctor

A sudden snap or pop at the back of the ankle followed by weakness or inability to push off the foot (possible rupture; seek urgent care)
Pain that persists despite several weeks of rest and home care
Severe pain or swelling that makes walking difficult
A visible gap or deformity in the tendon
Redness and warmth with fever, which could indicate infection

Frequently Asked Questions

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