✅ Medically reviewed by Dr. Thomas Biernacki, DPM — Board-Certified Podiatrist · Last updated April 6, 2026

What Causes Achilles Tendon Heel Pain?

If you’re feeling pain at the back of your heel where the Achilles tendon attaches, you’re dealing with one of the most common overuse injuries we treat at Balance Foot & Ankle. The Achilles is the strongest tendon in your body, but it’s also one of the most vulnerable to repetitive stress — especially in active adults over 40.

The Achilles tendon connects your calf muscles to your heel bone. When it’s overloaded — from too much running, sudden increases in activity, or chronically tight calves — the tendon fibers develop microdamage that triggers pain and inflammation. In our clinic, we distinguish between two main types:

• Insertional Achilles tendinitis — Pain and often a bony bump right where the tendon attaches to the heel bone. Affects both active and sedentary patients
• Non-insertional Achilles tendinitis — Pain in the middle portion of the tendon (2-6 cm above the heel). More common in younger, active patients
• Achilles tendinosis — Chronic degeneration of the tendon fibers without acute inflammation. The tendon may feel thickened and stiff
• Haglund’s deformity — A bony enlargement at the back of the heel that irritates the tendon and its surrounding bursa, sometimes called “pump bump”
• Retrocalcaneal bursitis — Inflammation of the fluid-filled sac between the tendon and heel bone, causing deep posterior heel pain

Symptoms of Achilles Tendon Problems

Achilles tendon heel pain has characteristic symptoms that help distinguish it from other causes of heel pain like plantar fasciitis. The key difference: plantar fasciitis hurts on the bottom of the heel, while Achilles problems hurt at the back.

• Stiffness and pain first thing in the morning — The tendon shortens overnight, and those first steps stretch it painfully
• Pain that worsens with activity — Running, jumping, and stair climbing increase tendon loading
• A visible or palpable bump — Especially with insertional tendinitis or Haglund’s deformity
• Tenderness when squeezing the tendon — You can pinch the tendon between your fingers and reproduce pain
• Swelling along the back of the heel — May be subtle in early stages, more obvious in chronic cases

Treatment Options

Home Treatments

• Eccentric calf exercises — The gold standard treatment. Stand on a step, raise up on both feet, then slowly lower on the affected side only. 3 sets of 15, twice daily for 12 weeks
• Heel lifts — A simple heel lift in your shoe reduces tension on the Achilles by 1-2mm, providing immediate relief
• Ice after activity — 15-20 minutes of ice to the posterior heel reduces inflammation
• Supportive shoes — Shoes with a slight heel rise (10-12mm drop) reduce Achilles strain. See our shoe recommendations
• Avoid flat shoes and going barefoot — Both increase tension on the Achilles

In-Office Treatments

• Custom orthotics with heel lift — Biomechanical correction plus elevation reduces chronic tendon loading
• Shockwave therapy (ESWT) — Stimulates tendon healing in chronic cases. Particularly effective for insertional tendinitis
• PRP injections — Platelet-rich plasma injections show promising results for tendinosis (chronic degeneration)
• Physical therapy — Guided eccentric loading program with progressive return to activity
• Immobilization — A CAM boot for 2-4 weeks in severe acute cases allows initial healing before starting rehab

Warning Signs: When to See a Podiatrist

Frequently Asked Questions

How long does Achilles tendinitis take to heal?

Most cases of Achilles tendinitis improve significantly within 3-6 months with consistent eccentric exercises and proper footwear modifications. The key word is consistent — sporadic stretching won’t cut it. Insertional tendinitis tends to take longer than non-insertional. If you haven’t improved after 3 months of dedicated conservative treatment, see a podiatrist for advanced options.

Should I rest or exercise with Achilles tendon pain?

Modified activity is better than complete rest. Total rest causes the tendon to weaken further, making it more susceptible to re-injury. The eccentric exercise protocol is actually a form of controlled loading that stimulates tendon healing. Avoid high-impact activities like running, but continue low-impact exercise like swimming or cycling.

Is Achilles tendon pain the same as plantar fasciitis?

No. Achilles tendinitis causes pain at the back of the heel where the tendon attaches. Plantar fasciitis causes pain on the bottom of the heel. They can occasionally occur together because tight calves contribute to both conditions. Treatment differs significantly, so accurate diagnosis matters.

The Bottom Line

Achilles tendon heel pain is a common overuse condition that responds well to eccentric exercises, heel lifts, and proper footwear in most cases. The most important treatment is consistent eccentric calf strengthening — this is supported by decades of evidence. If pain persists beyond 3 months or you experience a sudden pop, get evaluated promptly.

Clinical References

1. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy. 1998;14(8):840-843.
2. Alfredson H, Cook J. A treatment algorithm for managing Achilles tendinopathy: new treatment options. Br J Sports Med. 2007;41(4):211-216.
3. Silbernagel KG, Thomee R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy. Am J Sports Med. 2007;35(6):897-906.

Dr. Tom Biernacki, DPM

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Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.