Have you ever injured your achilles tendon? It’s easy to injure your achilles while running, jumping or pedaling a bicycle. Achilles Tendinitis is pain involving the calf muscle at the back of the lower leg.

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The image identifies the anatomy of the Achilles Tendon and the specific tendons of which it is comprised, Medial and Lateral Heads of Gastrocnemius and Soleus muscles.
This diagram identifies the various tendons which comprise the Achilles Tendon.

According to the National Institutes of Health, NIH, the achilles tendon is The strongest tendon in the human body. https://www.ncbi.nlm.nih.gov/books/NBK538149/

Did you know that a muscle or tendon shortening can lead to an injury? It can. A tendon contracture interferes with the tendon’s ability to perform at its optimal length predisposing you to injury.

What’s Unique about the Achilles?

The Achilles Tendon is unique in that this tendon actually crosses two joints, most tendons in the body only cross one. Since the Achilles originates (Begins) above the knee and attaches to the heel, it crosses both the knee and the ankle. Although the largest and strongest tendon in the body, the Achilles is one of the most likely to be injured.

Is the pain Acute or Chronic?

The term “Tendinitis” is commonly used covering both acute and chronic tendon abnormality. Actually, when looking at abnormal tendon under the microscope; only acute tendon injury was found to harbor inflammatory cells. Inflammatory cells are only present in the short term . Hence; only acute (recent or short-term) tendon injury is tendinitis. Chronic or older tendon injury is referred to as Tendinopathy or “Tendinosis”. Tendinopathy is understood to be the result of a degenerative process involving increased blood flow (hypervascularity), ectopic bone and cartilage (spurs) and disorganized cellular structure (disorganized extracellular matrix). There appears to be a link between untreated chronic tendinosis and acute Achilles tendon rupture.

Image result for achilles tendinitis free images. This diagram illustrates the various tendons which comprise the Achilles while the person is wearing a sock and shoe.
The various muscles which comprise the Achilles Tendon Complex

In my experience, most patients who come to the office have had some pain for a long time before they even made their appointment.

Is it Structural

Is it possible that your injury was caused by the the way your leg is made? Do you have a tendon contracture? In many cases patients whom I have treated have a built in or underlying physical trait which predisposes them to an injury. What I mean by this is a tendon contracture or shortening, something which can usually be remedied with physical therapy. If your tendon injury doers not respond to conventional treatment you may elect to try regenerative medicine treatment modalities instead. I also offer these.

Achilles Tendonitis Pain, Timing is Everything

Don’t underestimate your injury. Achilles tendinitis is often underestimated by the patient. This is unfortunate since musculoskeletal injuries have a better outcome the sooner the patient seeks treatment. Many patients have had pain for weeks, months or even years before they came in. In contrast, professional athletes have a team of doctors on the field at every game in case they get hurt. Why, because the sooner an injury is diagnosed and treated the faster the injury heals! According to scientific literature early treatment, as soon as possible results in the best outcome. An achilles tendon injury does not do well if left untreated for six weeks. Roberto Buda, Ph.D et.al. proposed a new decision making tool to guide treatment of achilles tendon injuries which considers not only the size of the tendon injury but also the health of the patient.

What is the fastest way to heal Achilles tendonitis?

The fastest way to heal an achilles tendonitis is to see a sports physician as soon as possible. Get a diagnosis and begin treatment. Be sure to follow all recommendations given to you.

Does Achilles tendonitis ever go away?

Although its theoretically possible that achilles tendonitis improves gradually over time, without seeing a sports doctor you will never know the actual severity of your injury.

What happens if Achilles tendonitis goes untreated?

Any neglected or ignored injury has the potential of either getting worse or simply never getting better. If the condition never gets better it will become a chronic problem.

How long does Achilles tendonitis take to heal?

The time it takes for an injury to heal is dependent upon the severity of the injury itself. A minor injury will heal faster whereas a more severe injury will take longer.

How Does Tendon Heal

Tendon healing after an acute rupture is divided into three stages; inflammatory, proliferative and remodeling. During the inflammatory stage bleeding forms a clot which becomes an early scaffold for incoming cells to the injury. The inflammatory cells are neutrophils, monocytes and lymphocytes which remove any necrotic (damaged) tissue. The second or proliferative stage starts two days after injury. Fibroblasts from surrounding tendon sheath or synovial sheath (tenocytes) arrive and increase in number. Macrophages release growth factors regulate activity at this point. Matrix is synthesized by the tenocytes made of collagen type III. Water and glycosaminoglycan content are also high during this stage. The final remodeling phase starts 1-2 months after injury. Tenocytes and collagen fibers spatially arrange in the direction of stress. At this time increased amounts of collagen type I is made and collagen type III and glycosaminoglycans decrease. After 10 weeks from injury and continuously for years fibrous tissue changes to scar-like tendon, it never regains the biomechanical properties it had prior to injury.

Acute Achilles tendon rupture area treated both conservatively and surgically. Conservative approaches including rest, cryotherapy, deep friction massage, eccentric loading, orthotics, and ultrasound have resulted in good to excellent outcomes in up to 75% of cases. Surgical repair in complete Achilles tendon ruptures in one study reduced re-rupture (4.4%), relative to non-surgical care (10.6%). The duration of Achilles tendon injury recovery is long, 9-12 months; and there is considerable residual impairment for the patient.

It is important to understand that healing after a tendon injury is a slow process even if you have surgery and that the healed tissue will result in a weaker tendon prone to re-injury.


Professional athletes have a team of sports medicine doctors available to them anytime the athlete gets hurt. You deserve to be treated the same way. Regardless of how long your pain has been present, it is not too late to be treated! The sooner you come in the better the outcome for healing. Nevertheless, most patients ignore their injury. If you have pain or an injury below the knee I can help, call for an appointment today.

Most important to remember:

Achilles tendon contracture or shortening can lead to an injury.

Untreated or neglected Achilles tendinitis can lead to a rupture.

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