Understanding Achilles tendon injuries and tendinosis: What you need to know

The Achilles tendon — the largest and strongest tendon in your body — connects your calf muscles to your heel. While it plays a vital role in walking, running, and jumping, it’s also vulnerable to injury, especially among athletes and active individuals. Knowing how to recognize and treat Achilles tendon issues can help you avoid long-term complications and get back on your feet faster.

What are Achilles tendon injuries?

Achilles tendon injuries include a range of conditions, most commonly:

• Acute rupture: A partial or complete tear of the tendon.
• Tendinosis: A chronic condition involving degeneration of the tendon tissue.

While often confused with tendinitis (inflammation), tendinosis is different — it’s a long-term breakdown of the tendon without significant inflammation. This distinction matters because it affects how the condition is treated.

Common causes and risk factors

Achilles tendon problems can result from a variety of factors. Age is a significant contributor, as tendons naturally lose flexibility and strength over time, making them more prone to injury. Sudden increases in physical activity — such as beginning a new exercise routine or intensifying training — can also exceed the tendon’s ability to adapt, leading to strain or damage.

Certain sports, including running, basketball, and tennis, pose higher risks due to repetitive jumping and quick directional changes. Poor training habits, inadequate warm-ups, and unsupportive footwear can further increase stress on the tendon.

Underlying medical conditions like diabetes and high blood pressure, as well as certain medications, have been linked to increased tendon vulnerability. Foot structure also plays a role — individuals with flat feet or high arches may experience added stress on the Achilles tendon.

Recognizing the symptoms

Acute rupture symptoms:

• A sudden "pop" or snap in the back of the ankle.
• Immediate, sharp pain.
• Difficulty pushing off the foot or standing on tiptoe.

Tendinosis symptoms:

• Gradual onset of stiffness or mild pain.
• Pain that improves with activity but returns afterward.
• Swelling or tenderness around the tendon.

Treatment options

Treatment depends on the type and severity of the injury:

For ruptures:

• Non-surgical: Immobilization in a boot or cast followed by physical therapy.
• Surgical: Reattaching the torn tendon, often recommended for younger or more active individuals.

For tendinosis:

• Conservative care: Rest, activity modification, physical therapy, and strengthening exercises.
• Other options: Orthotics, anti-inflammatory medications, or topical treatments.
• Surgical intervention: If conservative treatment fails, procedures may include removing damaged tissue or reconstructing the tendon.

The recovery process

Healing takes time and consistency. For ruptures, recovery may take four to six months or longer, with physical therapy playing an essential role in regaining strength and mobility. Tendinosis recovery is gradual and may take several months of consistent care.

The key to a successful recovery includes following a rehabilitation program consistently, gradually returning to activities and maintaining open communication with your healthcare team about your progress and any concerns.

Prevention tips

While not all Achilles tendon injuries can be prevented, you can lower your risk by:

• Gradually increasing your activity levels.
• Warming up before exercise and cooling down afterward.
• Stretching your calves and Achilles tendon regularly.
• Wearing supportive, activity-appropriate footwear.
• Cross-training with different activities to avoid overuse.

When to seek medical attention

Certain symptoms warrant immediate medical evaluation. If you experience sudden, severe pain in your Achilles tendon, especially if accompanied by a popping sensation, seek prompt medical care. For ongoing pain, stiffness or swelling that doesn’t improve with rest, consult a healthcare provider. Early treatment can prevent minor issues from becoming major problems.

Moving forward

Achilles tendon injuries and tendinosis can be frustrating, but with the right care and commitment, most people recover well and return to the activities they love. Healing takes time, but a personalized treatment plan and expert support can make all the difference.

HCA Florida Healthcare is here to help. We’ve helped thousands of Floridians return to active, pain-free lives. Our hospitals are ranked among the top five percent in the nation for orthopedic services and joint replacement. Call (844) 671-4206 to get connected with a doctor in the HCA Florida Healthcare network.