Achilles Tendinitis

Achilles Tendinitis

Achilles Tendinitis


If you happen to be someone who deep down truly hates to run through Central New York winters, but can’t come up with a suitable, respectable, incontrovertible excuse to take off say, six to twelve weeks……do I have the injury for you!

I cringe every time I see someone referred with Achilles tendinitis, for the simple reason that it is one of the most difficult athletic injuries to treat. Successfully, that is.

Why? Well, as the saying goes, The bigger they are, the harder they fall, and the Achilles is most certainly the largest, thickest tendon in the body. But what actually makes this a difficult problem is that there are so many parts of it that can be injured. As I’m sure all of you know, the Achilles tendon connects the calf muscles (gastrocsoleus) to the heel bone (calcaneus). Complete ruptures (fortunately rare in runners) most often occur at one of these connections. Partial tears usually take place at the musculotendinous junction or in the mid-substance of the tendon itself. What usually is called tendinitis is more often actually an inflammation of the thin tissue sheath which encases the Achilles. This is known as a tenosynovitis, and it is this problem which is most common in runners and generally falls within the category of classic overuse injury.

The symptoms of Achilles tenosynovitis include pain (naturally) which is usually worse the first few steps in the morning or after sitting for a while. Running, and sometimes walking, cannot be accomplished without a limp in many cases. Thickening of the affected area, due to inflammation initially and scar formation later on, can very often be felt by running the thumb and forefinger up the length of the tendon.

Treatment of this problem depends on the stage at which it is tackled. In the acute phase, ice and rest (if really severe, crutches are sometimes necessary for a few days!) are mandatory. This is not an injury to try to run through! If you catch it early enough, 2-3 days off may be all you need; it’s a move that can save you months, later. The lower-grade chronic tenosynovitis is really the most difficult to deal with. Heat, ultrasound and various soft-tissue massage/mobilization techniques combined with consistent, prolonged stretching are most effective. If not too severe, the chronic versions tolerate running as long as a good warm-up and stretching precede this activity. Hills and speedwork should be avoided, though.

The best treatment for Achilles tendinitis/tenosynovitis? Prevention! Maintaining proper flexibility of the calf and tendon via consistent stretching (wall stretch) is one key element that cannot be stressed enough. Shoes that do not have too much give in the rearfoot also help. Be wary of shoes that feel “like a pillow.” If the cushioning allows the heel to sink too far in when it strikes the ground, excessive stress may be placed on the tendon. And if you do stairs as part of your workout, be especially careful. In fact, unless you’re training specifically for a race to the top of a building, I’d recommend staying away from stair workouts altogether. There are too many bad things that can happen.

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).