Pain behind Heel – Achilles Tendinitis

The structure that we feel like a thick rope when we touch on the back of our heel is the Achilles tendon, the largest tendon in our body. A tendon is an extension of connective tissue fibers that attaches the muscle to the bone. Our calf muscles attach to the heel bone via the Achilles tendon. We use this tendon during walking, running, jumping, and toe elevation. Activities such as running and jumping more than usual can cause damage to the Achilles tendon and pain behind the ankle and heel.

Forcing, stretching, inflammation and edema of the Achilles tendon is called Achilles tendinitis. Achilles tendinitis can occur where the tendon attaches to the bone or a little higher in the middle section. Tendinitis means inflammation of the tendon. In the face of any injury or injury, our body creates an inflammatory response. The inflammatory response both fights against microbes, if any, and initiates the process of repairing the damaged tissue. Symptoms of inflammation include edema, increased temperature, redness, tenderness, and limitation of movement in the joint.

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What Causes Achilles Tendinitis?

Achilles tendinitis does not usually occur suddenly after a particular injury. Instead, what is called an overuse injury consists of repetitive strain or overtraining. In addition, rheumatic diseases and infections such as rheumatoid arthritis, ankylosing spondylitis can also cause tendinitis.

Neglecting pre-exercise warm-up movements, increasing the training intensity suddenly, overstraining the calf muscles, choosing inappropriate shoes may pave the way for the development of Achilles tendinitis. The risk increases in sports that involve quick stop and go, such as tennis. Wearing high heels all day can cause tendinitis. As age increases, tendons become weaker and more likely to be damaged or ruptured.

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Achilles Tendonitis Symptoms

There may be symptoms such as pain behind the heel, tension in the calf muscles, pain and limitation in ankle movements, a feeling of friction with wrist movement, swelling of the skin on the tendon behind the heel, thickening and irregularity of the tendon, tenderness and increased temperature. Calcification (calcification) between tendon fibers and bone growth such as spines may occur where the tendon attaches to the bone. Pain and stiffness may be greater in the morning and the day after exercise. Severe pain and swelling with a “crack” sound as a result of a sudden trauma may mean that the tendon has ruptured. If a tendon rupture is suspected, a doctor should be consulted immediately.


Except for complaints that develop after a sudden trauma, it is best to consult a physical therapy and rehabilitation doctor for heel pain. In traumatic events, depending on the severity of the situation, emergency service or orthopedic outpatient clinic may be applied. Diagnosis is made primarily by questioning the complaints and physical examination. In the examination, the presence of swelling, tenderness, temperature increase is evaluated by touching. It is checked whether the movements of the ankle are restricted. X-rays may be taken to distinguish bone problems. Tendon movements, edema, and fiber wear or tear can be seen with ultrasound. MRI (MRI) film can also evaluate soft tissues such as tendon, muscle and cartilage.


Initial treatment options are self-administered rest, cold application, gentle stretching exercises, and holding the foot up. Simple pain medications may be prescribed for short periods of time. The use of ankle braces or insoles may be helpful. If these methods are not sufficient, physical therapy can be performed. In physical therapy , tools such as TENS, hot or cold applications , ultrasound therapy , ESWT can be used. Eccentric strengthening exercises for the calf muscles can be beneficial if performed under the supervision of a physiotherapist. Injections containing cortisone can be done to reduce inflammation and edema. PRP treatmentIt is an innovative method that can be used to heal tendon injuries. Surgical methods may be considered as a last resort in people with ongoing complaints.

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