Achilles tendonosis/tendonitus

What is commonly referred to as Achilles Tendonitis in runners, is more properly called Achilles Tendinosis as no inflammation of the tendon is present in this condition. The injury is characterised by heel pain felt behind the ankle which causes limping. After diagnosis, a suitable programme of Achilles Tendonitis treatment can be initiated and cure with prevention of recurrence is possible for most sufferers of this common source of foot pain while running.


The heel pain is usually first noticed on getting up in the morning as weight is put on the affected foot. In the early stages, the resultant discomfort and limping usually wears off after a few minutes, and the diagnosis can be confirmed by pinching the Achilles Tendon between thumb and index finger, whereupon at least one tender area should be felt. If the injury is allowed to progress untreated, then heel pain during running will be experienced which ultimately can completely prevent training taking place.

Note that it is very important to distinguish between foot pain caused by Achilles Tendonitis (tendinosis) and the more serious condition of partial or complete Achilles Tendon rupture which requires urgent medical attention (surgery or immobilisation). If the heel pain comes on suddenly while running or is accompanied by weakness, then suspect a full or partial rupture rather than Achilles Tendonitis/Tendinosis and seek medical help quickly. Complete ruptures are less common in distance runners than they are in other sports like Tennis and Squash.


So, chronic well localised Achilles Tendon pain experienced by runners is now known to be Achilles Tendinosis and not Achilles Tendonitis. Tendonosis is a non-inflamatory degenerative condition, causing the tendon to lose its normal glistening appearance (not that you’ll usually get to see it). It is uncertain what triggers this, but excessive ankle pronation and/or the rapid alteration in calf muscle action as the heel strikes and then toe-off occurs, have both been put forward as possible causes.

Shoes that are too flat or worn out are thought to be a possible cause, as are shoes that do not adequately cater for the runners’ specific biomechanical needs (eg overpronation). Sudden increase in training load (particularly very long runs or speed/hill sessions) and tight calf muscles are both also thought to be potential factors.


Probably the most important thing to do is to stop running for a period of at least 7 days when the injury first appears. Ice packs should also be applied to the site of the heel pain, as although there is probably no inflammation, this may reduce the extent of tendon degradation. Note that it is not generally recommended to take anti-inflammatory medication for this condition. Careful return to a reduced training programme can then be attempted.

Runners with of all types of foot pain should also consider whether a new pair of shoes is required. Shoes wear out and lose their characteristics, but perhaps a change of make and type (motion control?) should also be considered. Some advocate that a ‘heel-raise’ insert in the shoe or full custom-made orthotic be utilised to treat Achilles Tendonitis problems.

Tight or inflexible calf muscles can be improved with a programme of stretching as described in The Lore of Running by Dr Tim Noakes. This can be a very effective treatment for many runners.

The injury and its recovery should be monitored by regularly pinching the tendon to feel for discomfort, and consideration given to seeking professional help from an appropriate therapist should the above measures not prove effective. In extreme cases (but only extreme cases) surgery may be required if the conservative treatments have all failed over an extended period.

The Lore of Running by Doctor Timothy Noakes, and the other books featured opposite contain information on the specifics of treatment and are highly recommended.

It is hoped that the information given here will be of use to those suffering from Achilles Tendinosis (formerly Achilles Tendonitis), but it is not a replacement for consulting with qualified professional therapists and medical experts who will be able to diagnose the condition and structure specific treatments plans.

Information Courtesy of Cole’s therapy & injury clinic


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