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Pain at the back of the heel is one of those problems people try to outlast. They swap shoes, skip a week of workouts, feel better, go back to normal — and the tendon is sore again within days. That cycle is the clearest sign that what you have is a tendon that has lost capacity, not a tendon that needs more rest.
First, rule out the emergency
Before anything else: if you felt a sudden snap or a sensation like being struck in the back of the calf, if you cannot rise onto your toes on that leg, or if you can feel a dip or gap along the tendon, that is not tendinitis. That pattern points to an Achilles tendon rupture, and how quickly it is assessed genuinely affects the outcome. Call us or go to an emergency department the same day.
Ordinary Achilles tendinitis builds gradually, hurts most at the start of activity, and eases as things warm up. It is uncomfortable and stubborn, but it is not an emergency.
Where it hurts changes what works
This is the single most useful thing to sort out early, because the two common forms respond to nearly opposite advice.
- Midportion — tenderness in the cord itself, an inch or two above the heel bone, often with a thickened spot you can feel. This form generally does well with progressive calf loading, including heel-drop work off a step.
- Insertional — tenderness right at the back of the heel bone where the tendon attaches, often with a bony prominence and pain that spikes in stiff-heeled dress shoes or walking uphill. This form is frequently made worse by those same heel drops, because dropping the heel compresses the tendon against the bone. We manage it with a different loading range and a heel lift instead. Our page on insertional Achilles tendinopathy covers that distinction in more depth.
Why we see so much of it around Bloomfield Township
The pattern here is less about sport and more about contrast. A lot of our patients spend the working day seated, then ask the tendon for a full effort in the evening — a racquet or pickleball session, a class, a long walk on pavement after months on carpeted treadmills. The tendon is not being overused so much as under-prepared for the load it is suddenly handed.
Footwear does its share of the damage too, and dress shoes are a common culprit in this office. A rigid heel counter that presses on an already-irritated insertion will keep a tendon angry for months no matter how disciplined the rest of the plan is. That is why we look at the shoes you actually wear all day, not just the ones you exercise in.
What the first visit looks like
We palpate the tendon to locate exactly where it is tender, test calf flexibility with the knee both straight and bent, and ask you to perform single-leg heel raises so we can see how much capacity the tendon has actually lost — that number is usually more revealing than the pain score. We also watch you walk. Then we explain which form you have, and what the next six weeks should look like.
Most people do not need imaging. We reserve it for tendons behaving unexpectedly, suspected partial tears, or when a procedure is on the table.
How we treat it
- Modify the load, do not eliminate it. A tendon that is completely rested gets more comfortable and no stronger.
- Build capacity deliberately. Slow, heavy calf loading has the best evidence behind it; our Achilles tendinopathy exercise guide shows the progression we work from.
- Change what is pressing on it — heel lift, a softer heel counter, and honest advice about which of your shoes to retire.
- Custom orthotics where foot mechanics, not training load, are driving the strain.
- Night splints when the first steps of the morning are the worst part of the day.
- In-office therapies for tendons that stall despite a properly executed loading program — see our laser, shockwave and EMTT options at this location.
The footwear conversation, in detail
For insertional Achilles pain in particular, what is on your feet between appointments often decides how the six weeks go. A few specifics we end up discussing with almost every patient:
- The heel counter. Press the back of the shoe between thumb and finger. If it is rigid exactly where your tendon is tender, that shoe is working against you regardless of how supportive it is elsewhere. Softer, lower-cut counters buy immediate relief.
- Heel-to-toe drop. A slightly higher drop shortens the working length of the tendon and usually feels better early on. Zero-drop and minimalist shoes are the opposite of what an irritated Achilles wants in the first few weeks, even if you tolerated them before.
- Dress shoes. Many of the men we see here are fine in trainers and miserable by the end of a workday. A stiff leather counter combined with eight hours of standing is a common reason a tendon refuses to settle. A temporary heel lift inside the dress shoe is often the single most effective change we make.
- Backless shoes and slides. Appealing because nothing touches the sore spot, but they let the heel drop and the tendon stretch with every step. Comfortable in the moment, unhelpful over weeks.
- What to retire, temporarily. We are usually not asking you to throw shoes away — most go back into rotation once the tendon has capacity again.
How long this actually takes
Plan on six to twelve weeks of consistent work to feel meaningfully better, with insertional cases toward the longer end. Tendon tissue remodels on that timescale and no treatment shortens the biology. What good care changes is whether those weeks are productive, and whether the problem returns the moment you go back to normal activity.
How we decide you are ready to go back
Returning on the calendar rather than on capacity is the most common reason a tendon flares a second time. We look for three things before clearing a full return:
- Symmetry in single-leg heel raises. The affected side should manage close to the same number of controlled repetitions as the other leg, not just “be able to do some.”
- A quiet morning. First-step stiffness should be gone or close to it. Morning stiffness is the most honest indicator we have that a tendon is still reactive.
- Tolerance of hopping. If light hopping on the affected leg is comfortable and stays comfortable the following day, the tendon has the elastic capacity that running and court sports demand.
Meeting all three usually means the return holds. Meeting one or two means we stage it — and staging a return is far quicker than treating a re-injury.
Questions we get asked
Can I keep playing while we fix it?
Usually, at a reduced volume and under an agreed pain threshold. Complete shutdown tends to delay the return rather than speed it.
Will a cortisone injection fix it?
We are cautious with steroid injection directly around the Achilles — it can weaken an already-compromised tendon. There are better options for a stubborn tendon, and we would rather discuss those.
Is the bump on my heel the problem?
Sometimes. A prominence at the insertion can rub inside a stiff shoe and keep the area inflamed. Often the bump has been there for years and the recent change in load is what made it symptomatic — which is good news, because load is the thing we can adjust.
Visiting our Bloomfield Township office
We are at 43494 Woodward Ave #208, Bloomfield Township, MI 48302, seeing patients from Birmingham, Troy, Auburn Hills, West Bloomfield and the surrounding communities. For an overview of everything we treat here, see our Bloomfield podiatrist page or our office locations. If your pain is underneath the heel rather than behind it, start with heel pain treatment instead. For the general clinical background on this condition, see our main Achilles tendinitis page.
To have an Achilles looked at, call (810) 206-1402.