Achilles Tendonitis In Runners: Causes, Prevention, And Treatment

Achilles Tendonitis In Runners: Causes, Prevention, And Treatment

Everyone has heard of the Achilles Heel. It means “a weak spot”. The phrase comes from ancient Greek myths. But the Achilles tendon is no myth. And an injury to the tendon can take an athlete down for weeks. Severe injuries can even keep them down permanently.

Thankfully, it’s easy to avoid Achilles tendonitis in runners.

And if one develops, they’re easy to treat. Once runners know the symptoms of Achilles tendonitis, they can spot it before it gets out of hand. Early diagnosis leads to a quick recovery and the runner will be back on their feet in no time.


Achilles tendonitis usually develops for one of two reasons. Either an athlete suddenly increases the duration or intensity of their training. Or an older athlete begins participating in intense once-weekly activities. These activities can range from running groups to pick-up games.

Injury occurs in these situations because athletes suddenly put new pressure on their Achilles tendon. A few additional factors can further increase the risk of injury. Addressing these factors can help reduce the risk of injury as well as assist in treating a current injury.

Risk Factors

Sex of the Runner

84% of Achilles tendonitis cases occur in men. Nobody is quite sure why this happens, but scientists have a few hypotheses. Men, on average, have larger calf muscles. This increases strain on the Achilles tendon. Some studies also indicate that estrogen may help prevent tendonitis, but nobody is quite sure why. Runners can’t easily change their hormone levels or calf sizes. But they can take care to stretch more if this factor affects them.


Our bodies change as they age. In some cases, the changes increase our risk of injury. The Achilles tendon, unfortunately, is one of those cases. The structure of the Achilles tendon weakens with age. This doesn’t mean we have to stop running, however. Older runners need to make sure they address as many other risk factors as possible. They can also stretch before and after runs to keep their muscles limber.

Flat Arches and Worn Out Shoes

Flat arches increase strain on the Achilles tendon. Arch support shoe inserts can help correct this issue. Worn out shoes pose a similar issue. They do not support the heel or foot arch. As with flat arches, this increases strain on the Achilles tendon. Runners must replace worn out shoes and ensure they have proper arch support.

Training Conditions

Runners who train in hilly conditions have an increased risk of tendonitis. Running outside in cold weather also increases a runner’s risk. Stretches can help decrease the strain from hill runs and compression sleeves (like ours below) may help keep calves warm.

Medical Issues

Certain medical issues increase a runner’s risk for Achilles tendonitis. A high body weight puts more pressure on the legs and tendons, for instance. Psoriasis and high blood pressure both affect swelling under the skin. And certain kinds of antibiotics increase a runner’s tendonitis risk. Runners should consult their doctors if there is a concern about their medication.


Achilles tendonitis has very few symptoms. The main symptom is a mild ache just above the heel or along the back of the leg. A new case of tendonitis will cause pain after going for a run or participating in sports. Once the condition settles in, stiffness and pain may occur first thing in the morning. This is due to the tendon and calf muscles tightening up overnight. Mild activity will ease the stiffness, but the pain will persist.

Recurring cases of tendonitis – or cases that have been left untreated – can cause pain at any time. The pain will be constant but may get worse after running or exercising. Certain activities like stair climbs, sprinting, and distance running are especially likely to inflame the injury.

Severe cases will progress from tendonitis to a rupture or tear of the tendon. Tears and ruptures cause severe pain and make walking difficult, if not impossible. These cases require immediate medical attention. Without immediate care, the issue can cause permanent damage that limits mobility and causes chronic pain.

Related Issues

Other issues may arise when an athlete develops Achilles tendonitis. These issues can range from stress fractures to flat arches. All of these issues will make it hard to walk, let alone run. If left untreated, they can progress to serious and permanent conditions.


Any athlete who suspects they’ve developed Achilles tendonitis should seek a doctor’s diagnosis. Doctors use MRIs or ultrasounds to confirm tendonitis. A doctor may also order an x-ray. X-rays cannot detect tendonitis but they will locate any stress fractures that the athlete may have. Once an athlete has a diagnosis, Achilles tendonitis can largely be treated at home. The most common treatment route is the RICE method, which the athlete applies at home. Athletes can also use over-the-counter pain medicine such as ibuprofen, but sparingly. They should not take painkillers just so they can get back on their feet. A little time and the RICE method are the best routes to a healthy tendon.

The RICE Method

R – Rest

The first thing an athlete should do is rest of their legs for a few days. This will give the tendon time to heal and for the swelling to go down. Athletes should rest until they are pain-free without medication. Once they are pain-free for a few days, they can slowly build back up to their normal training schedule.

I – Ice

Swelling around the injury causes most of the pain associated with Achilles tendonitis. A cold compress can help reduce swelling, especially when the pain is severe or right after an athlete exercises. It is important to properly wrap cold packs. Directly applying cold packs to the leg will damage the skin.

C – Compress

Wraps and compression sleeves can help reduce swelling. Since swelling causes most of the condition’s pain, this will help athletes get back on their feet. Athletes should make sure they only wear compression gear while exercising or for a safe period of time. If the packaging does not give a time frame, make sure to check the company’s website.

E – Elevation

Elevating the leg can also help reduce swelling. This is because elevation diverts some blood flow from the leg. Athletes should only elevate their leg slightly and for no more than 20 minutes at a time during the day. Elevation at night is a different story, however. Some doctors suggest elevating the leg very slightly all night to reduce stiffness in the morning. Athletes should consult their doctors before trying this, however.

Physical Therapy

Severe cases may require physical therapy. Each athlete will usually have a plan tailored to fit their needs, though they will likely encounter “eccentric” exercise. Eccentric exercise is incredibly useful in treating tendonitis. It requires athletes to raise a weight, then slowly lower it back down. Over time, it strengthens and stretches the injured tendons and muscles

Avoiding a Relapse

Tendonitis is a condition that never fully goes away. Once someone has dealt with it, that person is at risk of a relapse. Similarly, runners will never be able to completely remove the risk of Achilles tendonitis. There are, however, a few things runners can do to reduce their risk.

Increase Training Gradually

Athletes who suddenly increase the duration or intensity of their training are more likely to develop tendonitis. Gradual increases in training will help reduce this risk factor. This gives muscles and tendons the chance to adjust to new demands. Such an adjustment period greatly reduces the risk of injury.

Avoid Hill Running

Some runners really hate hills. Runners who like them, however, might struggle with this risk factor. Hill runs place a lot of strain on the Achilles tendon. Over time, this will cause tendonitis. If an athlete needs to run hills, they should stretch before and after every run.

Replace Old Shoes

Shoes wear down over time. This is especially true in the arch and heels of the shoes. Both of these areas need strong support if runners want to avoid injury. Shoes that don’t support the arch and heel greatly increase a runner’s risk of tendonitis. In these cases, it is time for new shoes. If a shoe still has good heel support, however, inserts may be a better option. Inserts will increase arch support until the heel wears down too and the runner replaces their shoes.


Every runner knows they should stretch. Some runners do this with a warm-up jog or brisk walk. Runners with a history of tendonitis, however, must go a step further. Static stretches will loosen up a runner’s muscles and tendons gradually. Only then should they attempt a job or warm-up walk.

Mix Activity Styles

Physical therapists often advise patients to rest their legs while they recover from tendonitis. This does not mean sitting all day, however. Athletes can swim or weight train, which keeps them moving without straining their legs. These activities should carry over once the athlete heals, as well. Mixing high and low-intensity exercise reduces the risk of a relapse. It also gives an athlete more activity options and works new muscles that running might not. While athletes are working with new muscles, their legs can rest and recover. This recovery is important for tendon health. And, as mentioned above, will keep athletes on their feet longer over time.

Strength Training

Runners rarely hit the weight room. But they should. Weight training is important for all athletes and runners are no exception. Spending some time in the weight room has a ton of benefits for runners. And one of those benefits is a decreased risk for tendonitis. Stronger calf muscles put less strain on the Achilles tendon. This then reduces the risk of tendon injury. A few days a week in the weight room is a small price to pay for tendon health.

  1. Mayo Clinic
  2. Ortho Info
  3. Kids Health
  4. Dr. Scholls
  5. AOFAS
  6. Runners World
  7. Niams
  8. RMD Open