Heel pain and Achilles tendonitis - aftercare

The Achilles tendon connects your calf muscles to your heel bone. Together, they help you push your heel off the ground when you stand up on your toes. You use these muscles and your Achilles tendon when you walk, run, and jump.

Heel pain is most often due to overuse of the foot. It is rarely caused by an injury.

Tendonitis due to overuse is most common in younger people. It can occur in walkers, runners, or other athletes.

Tendonitis from arthritis is more common in middle aged or older adults. A bone spur or growth may form in the back of the heel bone. This may irritate the Achilles tendon and cause pain and swelling.

You might feel pain in the heel along the length of the tendon when walking or running. Your pain and stiffness might increase in the morning. The tendon may be painful to touch. The area may be warm and swollen.

You might also have trouble standing up on one toe and moving the foot up and down.

Your health care provider will examine your foot. You may have an X-ray or an MRI to check for problems with your bones or with your Achilles tendon.

Follow these steps to relieve symptoms and help your injury heal:

• Apply ice over the Achilles tendon for 15 to 20 minutes, 2 to 3 times per day. Use an ice pack wrapped in a cloth. Do not apply ice directly to skin.
• Take painkillers, such as aspirin, ibuprofen (Advil or Motrin), or naproxen (Aleve, Naprosyn) to decrease inflammation and pain.
• Wear a walking boot or heel lifts if recommended by your provider.

Talk with your provider before using pain medicines if you have heart disease, high blood pressure, kidney disease, or have had stomach ulcers or internal bleeding in the past. Do not take more than the amount recommended on the bottle or by your provider.

To allow your tendon to heal, you should stop or decrease activities that cause pain, such as running or jumping.

• Do activities that do not strain the tendon, such as swimming or cycling.
• When walking or running, choose soft, smooth surfaces. Avoid hills.
• Gradually increase the amount of activity you do.

Your provider may give you exercises to stretch and strengthen the muscles and tendon.

• Range of motion exercises will help you regain movement in all directions.
• Do exercises gently. Do not over-stretch, which can injure your Achilles tendon.
• Strengthening exercises will help prevent tendonitis from coming back.

If your symptoms do not improve with self-care in 2 weeks, see your provider. If your injury does not heal with self-care, you may need to see a physical therapist.

Having tendonitis puts you at risk for an Achilles tendon rupture. You can help prevent further problems by keeping up with stretching and strengthening exercises to keep your foot flexible and strong.

Contact your provider if:

• If your symptoms do not improve or get worse
• You notice a sharp pain in your ankle
• You have trouble walking or standing on your foot

Brotzman SB. Achilles tendinopathy. In: Giangarra CE, Manske RC, eds. Clinical Orthopaedic Rehabilitation: A Team Approach. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 44.

Grear BJ. Disorders of tendons and fascia and adolescent and adult pes planus. In: Azar FM, Beaty JH, eds. Campbell's Operative Orthopaedics. 14th ed. Philadelphia, PA: Elsevier; 2021:chap 83.

Irwin TA. Tendon injuries of the foot and ankle. In: Miller MD, Thompson SR. eds. DeLee, Drez, & Miller's Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 118.

Silverstein JA, Moeller JL, Hutchinson MR. Common issues in orthopedics. In: Rakel RE, Rakel DP, eds. Textbook of Family Medicine. 9th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 30.

Updated by: Linda J. Vorvick, MD, Clinical Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.