Chronic Achilles Tendinitis

Achilles Tendon Pain
Causes and treatment for Achilles tendon pain lasting 3+ months

❓What Is Chronic Achilles Tendinitis?

The Achilles tendon, which connects the calf muscle to the heel bone, has pain lasting 3 months or more. Despite the name tendinitis, the chronic stage is now thought to involve degeneration of the tendon itself rather than active inflammation.
Repeated stress causes tiny tears in the tendon's collagen fibers to build up faster than the body can repair them, leading to a chronic condition.
Because the Achilles tendon has limited blood supply, healing takes longer. It is most common in recreational runners aged 30-60 and people who stand for long periods at work.

⚙️Why Does It Happen?

Overuse causes tiny injuries to build up

Repeated running and jumping create small tears in the tendon over time

Poor blood supply slows repair

The Achilles tendon has limited blood flow, so healing falls behind

Tendon breaks down and becomes chronic

The collagen in the tendon deteriorates, causing pain that lasts 3+ months

🏃 Overuse 🦵 Tight calves 🦶 Flat feet 👴 Aging 🚬 Smoking

🔍Watch for These Symptoms

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Achilles tendon pain with the first step in the morning

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Pain or swelling behind the heel after exercise

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Tenderness when pressing on the heel area

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Pain that has lasted 3 months or longer

💊Treatment

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Eccentric Exercises

Heel-lowering exercises continued for 12 weeks. A cornerstone of treatment

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Stretching

Maintain calf flexibility and reduce strain on the tendon

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Heel Lifts & Insoles

Raising the heel eases the load on the Achilles tendon (results vary from person to person)

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Shockwave Therapy

Thought to promote blood flow and the tendon's repair response. For the Achilles tendon it is not covered by insurance, so it is self-pay at our clinic (3,000 yen per session, tax included). Temporary pain, redness, swelling or bruising may occur at the treated site

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PRP Therapy

Uses growth factors from your own platelets to promote repair. However, in chronic Achilles tendinopathy it has not shown a clear benefit over placebo injection, so its role is limited. Not covered by insurance (self-pay)

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Anti-inflammatory Medication

Used short-term during periods of strong pain

📈Outlook & Recovery

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Many patients can expect improvement with load management and continued exercise

By continuing eccentric exercises and gradually managing the load, many patients see improvement. If left untreated, pain can become chronic and degeneration of the tendon progresses, which in rare cases leads to rupture. Please see a doctor if pain lasts more than 3 months.

🏃If You Have Achilles Tendon Pain

Chronic Achilles Tendinitis

Many patients can expect improvement with load management and continued exercise

💡 Keys to Recovery

🩻 Gotokuji Orthopedic Clinic