How to Treat & Prevent Achilles Tendonitis In Runners

black toenail from running

Do you ever feel pain in your Achilles tendon when running?

Or, perhaps just after you finish a run?

If so, then there’s a strong chance that you’re coming down with what’s known as Achilles tendinitis.

This is one of the nastiest running injuries that can put a stop to your running.

Worry not, I’ve compiled for you the full guide to Achilles tendonitis in runners.

By the end, you’ll learn:

  • What is Achilles tendonitis?
  • Why are runners prone to this injury?
  • The causes of Achilles tendonitis
  • The anatomy of the Achilles tendon
  • How to treat Achilles tendonitis
  • How to protect yourself from Achilles tendonitis
  • And so much more.

Feel excited?

Let’s get started.

Basic Anatomy & Functions

So what’s the Achilles Tendon

The Achilles (uh-KILL-EEZ) tendon is the strongest and biggest tendon in your body.

Located just behind and above the heel, this vital band of tissues connects the two major calf muscles—the gastrocnemius and soleus—to the back of the heel bone(calcaneum).

Its primary job is to transfer power to your ankle during both the walking and running gait.

The Achilles’ tendon is designed to withstand great force. The American Orthopedic Foot and Ankle Society says that it can hold the pressure of more than 1,000 lbs.

But this strength doesn’t make it bulletproof to injury.

The Trouble With The Achilles Tendon

In essence, Achilles tendonitis is an overuse injury of the Achilles’ tendon.

What causes Achilles tendonitis is still for debate, but tendinopathy happens when a tendon falls short of adapting to the strain being placed upon it.

This results in repeated micro-damage within the tendon fibers and causes the tendon to try to patch up itself in response to the strain.

As a runner, this usually happens when you overtrain or do too much too soon—the classic beginner’s mistake.

This painful condition causes soreness, swelling, weakness, and stiffness of the Achilles tendon.

Risk Factors For Achilles Tendon

Many things may increase your risk of Achilles tendinitis.

These include:

  • Age.  As a natural rule, the older you get, the higher the risk for the condition as it’s more common from the age of 30 onwards. The drop in the tendon elasticity makes it more prone to micro-tearing.
  • Gender. Male runners are more prone to Achilles tendinitis.
  • Biomechanical challenges. Having flat feet can put extra pressure on the Achilles tendon, causing tendinopathy in the process.
  • Bad running shoes. Running in worn-out and/or ill-fitting sneakers can increase your risk of the condition.
  •  Hard terrain. Unforgiving running surfaces, such as asphalt and concrete, is a major risk factor.
  • Medical conditions. Having high blood pressure, diabetes, or immunology issue may predispose you to Achilles tendinitis.
  • Tight muscles. Tight muscles in the calf, which forces the muscles to shorten, creating more tension in the tendon.

The Early Signs of Achilles Tendinitis

Achilles tendonitis pain often starts as a mild ache either above the heel or in the back of the leg after running.

You might also feel stiffness or tenderness, sometimes mimicking as cramp around the affected foot, especially in the morning, which often fades away with mild activity.

Other symptoms you might have include:

  • Redness or sweltering sensation in the Achilles area
  • Heel pain during or after running.
  • Swelling in the back of the heel or in the Achilles tendon itself.
  • Pain and stiffness in your Achilles, especially in the morning.
  • Poor ankle flexibility or tightness during plantar or dorso flexion.
  • Cracking sound during ankle movement

Additional resource – How to run in deep water

Achilles Tendonitis – The pain scale

Just like any other injury, Achilles tendonitis pain varies in severity.

Here’s how to grade your pain.

  • You usually feel pain when running or shortly after. But the pain not really disturbing and subsides during rest. You experience pain along the Achilles tendon during running.
  • Not only do you experience pain during activity, but you also notice swelling in the Achilles region, sometimes painful to touch. You may even feel a lump forming in the tendon.
  • Any type of weight-bearing causes pain in the Achilles region. The swelling along the Achilles may also be accompanied by points of sharp pain. In extreme cases, the Achilles tendon may tear completely. This causes serious pain.

Complications of Achilles Tendonitis

Ignored, scar tissue begins to form, which impedes blood circulation to the tendon, preventing the ligament from healing.

Yes, the remodeling still happens, but it will turn into fibrosis.

Just like skin with keloid, misplaced fibrosis also no good.

It can be weaker and less elastic, making it more prone to a tear, which is a serious injury that requires surgical intervention.

Over time, this can lead to a degenerative tear of the Achilles tendon itself that shows as a lump in the reign.

This condition can progress into Achilles Tendinosis, which is chronic inflammation with fluid, where it limits your ability to even jog slowly.

Surveys show that roughly 66 percent of Achilles tendonitis cases strike the midpoint of the tendon, a few inches above the heel.

achilles pain

How to Treat Achilles Tendonitis

If you suspect Achilles tendonitis—or just have pain in your Achilles during or after a run—take the following steps to soothe your pain and prevent it from getting worse.

The Road to Recovery

If you caught this condition early on, Achilles tendonitis might heal on its own with some simple treatment measures at home.

It may take at least three months or more for the pain to fully go away, according to The American Academy of Orthopedic Surgeons.

That’s why the sooner you start treatment, the better off you’ll be…

Step 1: Rest

Taking a step back from running—or any other high impact activity you are doing—should be your first step toward complete Achilles tendinitis recovery.

During your relative rest period, cross-train, doing low impact exercises such as swimming, aqua jogging, strength training, yoga, and cycling.

The non-weight bearing exercise is the solution for this period.

Don’t force yourself to go beyond your pain at least three weeks.

Step 2: Ice Therapy

Apply ice to the Achilles’ tendon for no more than 15 minutes several times per day.

Less than 10 minutes has little effect, and over-icing (more than 30 minutes) may damage the skin.

Take Meds

Feeling intense pain?

Take Nonsteroidal anti-inflammatory such as ibuprofen to help with the pain and the swelling.

Just be careful with medication as it only helps cover the symptoms, which may cause the condition to get worse.

You can use a foam roller and hot water packs to lessen up your lower legs at night and in the morning.

When To See A Doctor

If you still suffer from persistent pain around the Achilles tendon in spite of taking rest and proactive measures, call your doctor.

Symptoms not improving?

Consult a doctor.

Avoid taking any medicine before your appointment. .

Painkiller will cover the pain level which leads to misdiagnosing the stage you’re in.

In some cases, surgery is required to remove scar tissues around the tendon, but according to my research, this is not the best solution as it may stimulate more scar tissue.

What most experts recommend is addressing the root of the problems instead of just treating the symptoms.

Most notably, work on improving flexibility and mobility in your calf muscles.

Foam rolling has been shown to help a lot

Return To Running After Achilles Tendonitis

Once the pain starts to subside, gradually return to running.

Here are the three main stages of Achilles Tendinitis rehab in runners

First stage – The Injury Period

The first stage can last up from two to five weeks and involves a lot of rest, a lot of boring rest.

During this phase, focus on resting the injured limb as often as possible.

RICE will be your daily routine.

Feel free to cross-train, but remember this rule: If it’s painful, don’t do it.

Second Stage – The Dynamic Work Period

This is when you’ll start doing some dynamic work.

This phase may last up to three weeks, and you’ll be doing plenty of drills, such as hopping drills, to get your Achilles used to some impact.

You can also work on strengthening and mobilizing the injured part, doing plenty of heel rises and foam rolling.

You can move to the next stage once you can perform toe raises,  free hops, jumping jacks, backward lunges without pain.

When you can dorsiflex and plantarflex without suffering, there you ready to move on to the next stage.

Third stage – The Return To Running Period

In most cases, expect to be back to running in in six to eight weeks—depending on the severity of your condition and your recovery plan.

The rules are simple:

  • Pick up running again but in a slow and gradual manner.
  • Back off or stop training altogether if you feel pain either during or after your runs.
  • Alternate between running days and rest days, or make the rest day longer than usual.

This stage should take you up over two to three weeks to build up your weekly mileage to the pre-injury levels.

Keep in mind that this is just a suggested guide.

It’s not written in stone.

Every runner will respond to this differently, and each Achilles injury is unique.

Listen to your body and re-adjust accordingly.

Re-assess every two weeks how your progress is going on.

You call the shots.

Preventing Achilles Tendinitis

Although it may not be possible to prevent Achilles Tendinitis—especially if you’re keen on running—there are a few measures you can take to reduce your risk.

Take the following steps to reduce your risk.

Three Achilles Tendon Exercises

Working on stretching and strengthening your Achilles can help you prevent (re-)injury.

Do the strength exercises (3 sets of 15 reps) at least four times per week.

Opt for the two stretch moves as part of your post-run routine.

You should always stretch after a run.

  1. Calf Raises
  2. Stand tall on both feet
  3. While using a wall or a chair for support, slowly raise up on to your tiptoes
  4. Hold for a moment
  5. Then slowly drive your heels to the ground.

During this exercise, focus on the eccentric rather than the concentric part of the exercise (e.g., the calf lowering rather than the calf raising).

Start off by using your body weight, doing four sets of 12 or 15 reps each day.

If you feel strong enough, use the calf raise machine in the gym.

  1. The Seated Calf Stretch
  2. Sit up straight on the floor or an exercise mat.
  3. Bend your left knee, and straighten the right knee while flexing.
  4. Wrap a towel or a long piece of elastic around the ball of your right foot, then pull your toes towards you, keeping the knee straight.
  5. Hold it for 30 seconds, then switch sides. Make sure that your back is straight throughout the stretch.
  6. The Calf Runners Stretch
  7. Put both hands on the wall, feet a little apart, with one foot in front of the other.
  8. Bend your front knee but keep your back knee straight, then lean in towards the wall and press through your back heel until you start feeling a stretch in your back calf.
  9. Hold for 30-seconds and switch sides.

Wear Proper Shoes

As a runner, your main armor is your shoes..

Without proper ones, you’ll fall into injuries.

Your running shoes should provide proper cushioning for your heel and should provide stable arch support to help ease tension in the Achilles tendons.

Head to the nearest specialty running store and have your running gait and foot type analyzed by the pro stuff.

They’ll make the proper recommendations for you.

Also, remember to replace your running shoes every 400-500 miles.

Running in worn-out shoes defeats the purpose.

You should also consider using shoes with a slightly higher heel-to drop with nice elastic padding.

This may help reduce the stress on the tendon.

What’s more?

Avoid walking around barefoot or in zero-drop shoes as these can further irritate your Achilles tendon.

Make it a rule to provide your Achilles with more support, especially during the recovery period.

You may also consider adding an orthotic to help you regulate and normalize your gait mechanics.

This is especially the case if your running shoes are still in good condition but suspect that they may not properly support your arch and heel.

Please consult your doctor or orthopedic to find the best suits orthotic for you.

Remember, OTC orthotics not always fits perfectly since everyone has different feet anatomy.

Stick to The 10 Percent Rule

To avoid doing too much soon (the root cause of most running injury), stick with the 10 percent rule.

It’s quite simple.

Do not increase your running mileage (or time) by no more than 10 percent from one week to the next.

Are you a beginner runner?

Forget about the 10 percent rule.

Instead, focus on gradually building enough endurance to run straight for 30 minutes at an easy pace and without panting for air.

Make it your goal to get fit without getting hurt.

The rest is just details, as the saying goes.

And if you are a complete newcomer to running, then forget about the 10 percent rule and only focus on building enough cardiovascular power to run continuously for 30 minutes without much huffing puffing.

Your goal should be to get fit without getting hurt.

Proper Warm-up

Start off your runs with a proper warm-up.

An ideal warm-up consists of 5-minute brisk walking, some light stretching, then you could steadily break into your normal running pace.

Here’s a fantastic warm-up routine to perform before your runs.



Here’s the bad news.

We are not robots, and there’s no spare part for our bodies.

No real cure for an overuse injury.

Achilles tendonitis occurs because of damage to the tendon, and if if you run, you’re bound to cause some damage.

Healing damaged tendons requires recovery time and acute attention.

Understanding the injury and incorporating the tips above into the recovery plan is a good place to start.

If symptoms don’t improve, seek out a physical therapist to help you with your recovery.

Feel free to ask for second opinion if you’re still in doubt about surgical issues.