Achilles Tendonitis
Pain along the back of your heel or lower calf usually points to Achilles tendonitis — inflammation of the tendon connecting your calf muscles to your heel bone. It's common in runners, weekend athletes, and anyone who suddenly increases activity.
Symptoms
- Pain along the back of the heel, especially after exercise
- Stiffness in the morning that improves with gentle movement
- Swelling that worsens throughout the day
- A thickened or tender tendon you can feel with your fingers
Who Gets It
Achilles tendonitis is most common in runners who've increased mileage too quickly, athletes returning to activity after time off, and middle-aged adults who are active on weekends but sedentary during the week. Tight calf muscles, overpronation, and running on hills all increase the load on the tendon.
Austin's Hill Country routes and Brushy Creek trails are hilly — and hills put significantly more strain on the Achilles than flat running. Distance runners training for Austin marathons and triathlons are common patients. Dr. Wokasien understands training loads and builds recovery plans that respect your race calendar.
Treatment
The Achilles tendon heals slowly because of limited blood supply. Dr. Wokasien builds a recovery plan that respects this biology:
- Targeted eccentric stretching exercises — the most evidence-backed treatment for Achilles tendonitis
- Activity modification to reduce tendon load without stopping all movement
- Custom orthotics to correct biomechanics contributing to the strain
- Anti-inflammatory strategies for acute flare-ups
- Heel lifts to temporarily reduce tension on the tendon
Complete rest is usually counterproductive. The goal is controlled loading that promotes healing.
When to Call
Achilles pain that persists beyond a week, or that returns every time you increase activity, needs professional evaluation. A partial tear misdiagnosed as tendonitis leads to a full rupture. Call (512) 250-0444.
Frequently Asked Questions
How long does Achilles tendonitis take to heal?
Most cases improve significantly within 6-12 weeks of consistent treatment. Chronic tendonitis — the kind that's been ignored for months — can take 3-6 months. The Achilles heals slowly due to limited blood supply, so patience and a structured loading program matter more than rest alone.
Can I keep running?
Often yes, with modifications. The approach depends on severity. Dr. Wokasien builds activity plans that maintain fitness while reducing tendon load. In most cases, complete rest is counterproductive — controlled, progressive loading actually promotes tendon healing better than stopping entirely.
What are eccentric exercises and why do they work?
Eccentric exercises involve lengthening the muscle under load — specifically, lowering your heel slowly off a step. Research consistently shows this type of loading remodels damaged tendon tissue more effectively than rest or concentric exercises. Dr. Wokasien prescribes a specific protocol based on your condition.
Could my pain be a partial tear rather than tendonitis?
Possibly. Partial tears cause similar symptoms but require different management — and pushing through a partial tear risks a complete rupture. Dr. Wokasien uses clinical examination and imaging when needed to distinguish between tendonitis and a structural tear. Don't assume it's just tendonitis.
What's the difference between insertional and non-insertional Achilles tendonitis?
Insertional tendonitis affects the point where the tendon attaches to the heel bone. Non-insertional affects the middle portion of the tendon, a few centimeters above the heel. They have different causes and respond to somewhat different treatments. Dr. Wokasien identifies which type is present before starting treatment.
Do custom orthotics help Achilles tendonitis?
For many patients, yes. If overpronation or foot mechanics are increasing tendon stress, orthotics reduce the underlying cause. A heel lift can also temporarily reduce tension on the tendon during the acute phase. Dr. Wokasien evaluates your gait as part of the diagnosis.
When does Achilles tendonitis require surgery?
Surgery is rarely needed — considered only when 6+ months of consistent conservative treatment, including structured eccentric loading, hasn't provided relief. Surgical options include tendon debridement or repair, depending on the extent of degeneration. Dr. Wokasien will discuss expectations honestly before recommending any procedure.