Achilles Tendinitis Treatment 2026: Michigan DPM | DPM

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Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Township, MI. Last updated April 2026.

Achilles Tendinitis Treatment Michigan

Achilles tendinitis (tendinopathy) is inflammation and degeneration of the Achilles tendon — the thick cord connecting your calf muscles to your heel. It is one of the most common overuse injuries in runners and active adults, and a leading cause of heel and posterior ankle pain. At Balance Foot & Ankle, Dr. Tom Biernacki DPM provides evidence-based Achilles tendinitis treatment in Michigan at our Howell, Brighton, and Bloomfield Township offices.

Types of Achilles Tendinopathy

• Non-insertional Achilles tendinopathy: Affects the mid-portion of the tendon, 2–7 cm above the heel. Most common in runners. Presents as a fusiform (spindle-shaped) thickening and pain in the tendon body.
• Insertional Achilles tendinopathy: Affects the attachment of the tendon to the calcaneus (heel bone). Often associated with Haglund’s deformity and retrocalcaneal bursitis. Worsened by shoe collar irritation.

Symptoms

• Posterior heel or ankle pain, stiffness, and swelling
• Worse after rest — “start-up pain” that eases as the tendon warms up
• Tender tendon or tendon insertion on palpation
• Visible or palpable thickening of the Achilles tendon
• Worsened by hills, stairs, and sprinting

Diagnosis

Dr. Biernacki evaluates the tendon with in-office diagnostic ultrasound — the gold standard for tendinopathy assessment. Ultrasound reveals tendon thickening, neovascularization, hypoechoic degeneration, and calcification in real time. It also rules out partial or complete tendon tears. MRI is reserved for pre-surgical planning or when tendon tear is suspected.

Treatment Options

Eccentric heel drop exercises — the Alfredson protocol — are the most evidence-based conservative treatment for non-insertional Achilles tendinopathy. Performed on a step, twice daily, they load the tendon eccentrically to stimulate collagen remodeling. Results are seen at 12 weeks.

Custom orthotics with a heel lift reduce tensile load on the Achilles tendon during daily activities. For insertional tendinopathy, a heel lift significantly offloads the insertion.

Platelet-rich plasma (PRP) injection is an in-office procedure where Dr. Biernacki concentrates growth factors from your own blood and injects them into the degenerated tendon under ultrasound guidance. PRP is particularly effective for chronic, recalcitrant mid-tendon tendinopathy and provides superior outcomes to corticosteroid injection (which weakens tendon tissue).

Extracorporeal shock wave therapy (ESWT) applies acoustic energy to the tendon, stimulating healing and reducing chronic pain. Dr. Biernacki offers in-office ESWT for both insertional and non-insertional tendinopathy.

Surgical debridement — removing the degenerated core of the tendon — is performed through a minimally invasive approach for cases failing 6+ months of comprehensive conservative care. FHL tendon transfer augmentation is added when more than 50% of the tendon cross-section is involved.

Frequently Asked Questions

Book your Achilles tendinitis consultation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Township, Michigan.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Achilles Tendonitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Haglund’s deformity. Bony bump at the back of the heel rubbing against the shoe counter.
• Insertional vs. mid-substance Achilles. Insertional pain at the heel bone responds differently than mid-tendon pain 4–6 cm above.
• Retrocalcaneal bursitis. Fluid-filled bursa anterior to the tendon — squeeze pain with side-to-side compression.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stretching the Achilles into pain during rehab. Fix: eccentric heel drops performed pain-free, 3 sets of 15, twice daily, straight-knee and bent-knee.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your Achilles tendon conditions, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.

Frequently Asked Questions

What’s the difference between Achilles tendinitis and tendinosis?

Tendinitis is acute inflammation (early-stage, under 6 weeks). Tendinosis is chronic degeneration without active inflammation — collagen breakdown, microscopic tearing, thickening. This distinction is critical for treatment: tendinitis responds to rest and anti-inflammatories; tendinosis does NOT respond to NSAIDs or ice because there’s no active inflammation to suppress. Tendinosis requires eccentric loading therapy and often PRP to stimulate collagen repair. Many patients treat tendinosis like tendinitis for months, prolonging recovery unnecessarily.

Will Achilles tendinitis lead to a rupture?

Untreated Achilles tendinopathy increases rupture risk — but it’s not inevitable. Risk rises significantly when patients continue high-impact activity through moderate-to-severe pain, or return to sport before the tendon has healed. In our practice, patients who complete a structured eccentric loading protocol have roughly a 3% rupture rate. Those who ignore the condition and keep training have rates closer to 15–20%. Early treatment isn’t optional — it’s rupture prevention.

How long does Achilles tendinitis take to heal?

Insertional Achilles tendinitis (at the heel bone) typically takes longer than mid-portion tendinitis — often 3–6 months with consistent treatment. Mid-portion responds faster, usually 6–12 weeks. The biggest predictor of recovery time is how long you’ve had symptoms before starting treatment. Patients who begin care within 4 weeks recover twice as fast as those who wait 6+ months. Chronic tendinosis can require 12–18 months even with optimal care.

What is eccentric heel drop exercise and does it work?

Eccentric loading — raising on both feet on a step and lowering slowly on the injured foot alone — is the single most evidence-supported treatment for mid-portion Achilles tendinopathy. The Alfredson protocol (3 sets of 15 reps, twice daily, over 12 weeks) shows 60–80% success rates in research. The mechanism: controlled overload stimulates collagen remodeling and tendon thickening. It should be done on a step edge with a heel drop below level — flat-surface heel raises are significantly less effective.

Can I exercise with Achilles tendinitis?

Yes, with modification. Low-impact activity — swimming, cycling, elliptical — is generally well-tolerated and maintains fitness without loading the tendon. Running can often continue at reduced volume (30–40% less) if pain stays below 4/10 during activity. Plyometrics, hill running, and speed work should stop until the tendon is at least 70% healed. The key rule: some discomfort during eccentric exercises is acceptable; sharp or worsening pain means stop.

Should I use heat or ice for Achilles tendinitis?

For acute tendinitis (first 2–4 weeks): ice after activity to reduce inflammatory pain. For chronic tendinosis: heat before exercise to increase blood flow; ice after to reduce post-exercise soreness. Many patients with chronic tendinosis use ice exclusively and wonder why they’re not improving — cold vasoconstricts the tendon, reducing the blood flow that chronic degeneration requires to heal. If symptoms have been present more than 6 weeks, switch your protocol.

What shoes help Achilles tendinitis?

A heel lift of 8–12mm is the most impactful footwear modification — it reduces the mechanical stretch of the tendon during gait. Motion-control or stability shoes work better than neutral shoes for most patients. Avoid minimalist and zero-drop shoes entirely during treatment. Temporary heel lifts (3/8″) added to regular shoes are a quick way to assess whether elevation helps before investing in specific footwear.

What is PRP therapy and does it work for Achilles tendinopathy?

PRP (Platelet-Rich Plasma) involves drawing your blood, concentrating the growth factors via centrifuge, and injecting them into the tendon under ultrasound guidance. For chronic mid-portion Achilles tendinosis that hasn’t responded to 12+ weeks of eccentric exercise, PRP shows 60–75% success rates in systematic reviews. Results take 6–12 weeks to manifest. We use ultrasound guidance for all tendon injections to ensure accurate placement. PRP is generally not covered by insurance but is typically $400–700 per treatment.

Does Achilles tendinitis affect both feet?

Most cases are unilateral (one side), typically the dominant-leg side or the side of greater mechanical load. Bilateral Achilles tendinopathy can occur in runners who dramatically increase training volume, but also warrants evaluation for systemic conditions — particularly fluoroquinolone antibiotic use (ciprofloxacin, levofloxacin are known to weaken tendons), seronegative arthropathies, and hypothyroidism. If both tendons are symptomatic without a clear mechanical cause, a systemic workup is appropriate.

When does Achilles tendinopathy require surgery?

Surgery is considered after 6–12 months of failed conservative management. Procedures include debridement of degenerated tissue, calcification removal (for insertional tendinopathy), and in severe cases, tendon reconstruction with FHL transfer. About 10–15% of patients with Achilles tendinopathy eventually need surgery. The outcomes are generally good — 80–90% return to activity — but recovery takes 6–9 months. We always exhaust shockwave therapy and PRP before recommending surgery.

Is Achilles tendinitis related to plantar fasciitis?

They often co-occur and share common risk factors: tight calf muscles, overpronation, rapid training increases, and inadequate footwear. Mechanically, a tight gastrocnemius (calf) increases load on both the Achilles insertion and the plantar fascia. Treating one effectively often improves the other. If you have both conditions simultaneously, the rehabilitation protocol is similar — eccentric calf work and dorsiflexion stretching address both pathologies.