Foot Health Blog
Find expert articles from physical therapists and podiatrists to help understand, diagnose, and treat different foot health issues such as plantar fasciitis, bunions, flat feet, and more.
Achilles tendonitisHeel Pain: How Achilles Tendonitis and Plantar Fasciitis DifferAchilles tendonitis and plantar fasciitis are two common causes of pain in the foot and are frequently confused. This is because they both cause pain in the heels, with similar symptoms that worsen when weight is placed on the leg and foot.
However, there is a stark difference between these conditions. Chief among these differences is the location of pain and the aggravating factors.
Let’s find out more about each condition and how they compare.
What Is Achilles Tendonitis?
Achilles tendonitis is a chronic overuse injury of the Achilles tendon—the band of tissue that links the calf muscles to the heel bone. It is caused by placing excess strain on the Achilles tendon. Depending on where the strain occurs, you can have insertional tendonitis or non-insertional Achilles tendonitis.
What Is Plantar Fasciitis?
Plantar fasciitis is the inflammation of the plantar fascia—the band of connective tissue that runs from the ball of the foot to the heel.
Differences Between Achilles Tendonitis and Plantar Fasciitis
Although Achilles tendonitis and plantar fasciitis both cause heel pain, there are vast differences between the two based on their causes, presentation of symptoms, treatment, and recovery.
Achilles tendonitis is caused by excess strain from being overweight or a sudden increase in intensity and duration of exercises and other physical activities. It may also be due to training with improper shoes, on uneven surfaces, or without warmup. Being overweight, male, and over 30 can also increase your risk of developing Achilles tendonitis.
Plantar fasciitis occurs as a result of prolonged strain on the feet from overuse or overstretching of the fascia. Plantar fasciitis is a major cause of pain in the heel.
Achilles tendonitis causes sharp, aching pain around the heel bone. Related symptoms like tenderness, swelling, loss of range of motion, and tight or weak calf muscles may also occur.
Plantar fasciitis causes a stabbing pain in the heel. The pain is often restricted to the area around the heel, although it may also spread to the toes.
While Achilles tendon pain is most intense during activity, plantar fasciitis causes the most pain immediately after rest or activity.
The main reason you need to accurately determine if you have Achilles tendonitis or plantar fasciitis is that the ways to treat and manage the conditions differ.
With Achilles tendonitis, home treatments (rest, ice, use of NSAIDs, etc.) can help with pain relief. However, exercise (strengthening, balance, and plyometric exercises) and activity modification are the most effective management methods. Exercises aim to improve the strength of the calf muscles. Orthotics that are placed under the heel can also be used.
Similarly, plantar fasciitis can be managed with home treatment and other conservative treatment approaches. It differs, however, as the exercises aim to stretch the foot arch, and insoles will offer arch support. Shock wave therapy can also be used to stimulate the healing of damaged tissues.
For both conditions, if there is no improvement despite conservative management, surgery may be necessary.
Once either condition is diagnosed, it is best to begin intervention immediately as both conditions can lead to back, hip, and knee problems. They can also cause gait abnormality and lead to several other complications.
Full recovery after Achilles tendonitis will take 3–12 months, even with surgery.
The healing time for plantar fasciitis is faster with surgery (3–4 months) but longer (6–18 months) without surgery.
Can You Have Achilles Tendonitis and Plantar Fasciitis at the Same Time?
Despite all the differences between the two conditions, you can suffer both simultaneously. In fact, it is called plantar tendonitis when both conditions occur together.
The interrelationship is not surprising, as both structures work together to ensure forward motion. For example, tight calf muscles will make the Achilles tendon taut. A tight Achilles will strain the plantar fascia as the pull will transfer from the Achilles tendon to the fascia.
Orthotics for plantar fasciitis and orthotic insoles for Achilles tendonitis present an excellent way to manage both conditions. These orthotics must possess a firm but cushioned arch support to protect the heel and reduce the strain on the Achilles tendon and plantar fascia. So even if you have both Achilles tendonitis and plantar fasciitis concurrently, custom orthotics can help improve both conditions immediately. Achilles tendonitisAchilles Tendinopathy vs. Tendonitis: Differences and DefinitionsTendinopathy and tendonitis are two types of Achilles tendon pain and are often confused as their symptoms are extremely similar, and the injury occurs in the same region. Both conditions cause pain at the insertion point of the tendon or along the length of the tendon and are associated with exercise exertion.
However, they are two different conditions with several distinctions. Where tendinopathy is a breakdown of the protein fibers making up the tendon, tendonitis refers to inflammation of the tendon.
What Is Tendinopathy?
Achilles tendinopathy is characterized by the degeneration of the collagen fibers that make up the tendon. Micro-tears in the fibers are often caused by overexertion or repetitive strain on the tendon through running or jumping activities. This condition points to a tissue disorder, namely repetitive damage to the tendon, which fails to heal adequately.
This condition also commonly occurs in the shoulder, elbow, and wrist. With time and rest, the symptoms usually subside. In severe cases, where adequate time for collagen fiber healing has not taken place, severe injury or rupture can occur to the tendon due to the ongoing breakdown of the collagen fibers. Surgical intervention is then required to manage the condition effectively.
What Is Tendonitis?
Tendonitis, especially in the Achilles tendon, is marked by pain and inflammation in the tendon. The tendon becomes irritated and can feel painful due to the regular and repetitive strain placed on the Achilles tendon from walking or running. Point tenderness, warmth, and swelling over the inflamed tendon are common. Pain is associated with Achilles tendonitis and is commonly caused by activity and exertion as well.
Achilles tendonitis usually occurs at the insertion point of the tendon with the calcaneus bone, known as insertional Achilles tendonitis. This is the likely spot for pain and discomfort to occur.
Differences Between Tendinopathy and Tendonitis
Running on hard surfacesRepetitive running or jumping activitiesCalcium deposits in the tendonHigh loads out through the tendonHeel bone spursPoor lower leg and ankle biomechanics
Sudden injury to the tendon, usually as a result of high loadsRepetitive movements that place strain on the tendonPoor posture and lower leg biomechanics
Pain or a burning sensation in the Achilles tendonDifficulty moving the joint due to stiffness and associated painMuscle weaknessPain in the area when rising onto the toesSwelling notes in the area of the Achilles tendonIn severe cases, reduced mobility and high levels of pain
Pain or discomfort at the insertion point of the Achilles tendon or in the middle of the tendon fibersSwelling in the areaPain when touching the inflamed areaBony prominence forming on the heel boneStiffness in the tendon and ankle jointIn severe cases, reduced mobility due to painIn severe cases, high levels of pain are associated with damage to the fibers of the tendon
The treatment goals for both conditions are to reduce inflammation and pain and improve overall mobility. The following are the primary treatment strategies:
Applying ice to the affected area effectively reduces inflammation during the acute phases of pain.
Wearing orthotics in your shoes can be very helpful in combating the symptoms arising from these conditions. Orthotic insoles support the foot and ankle while distributing the weight evenly through the entire foot, lessening the strain on the Achilles tendon.
Stretching the calf muscle is another excellent way to manage both conditions and prevent them from worsening.
Achilles Tendon Exercises
Exercises for the Achilles tendon are beneficial in strengthening the tendon's fibers and muscles around the area for increased stability. Heel raises, resistance TheraBand exercises, and range of motion exercises are all helpful in managing this condition effectively. Exercises should only be done if there is no pain in the heel area.
Not overexerting yourself or doing too much too soon is vital to prevent exacerbating the problem. When running with Achilles tendonitis, it's advised to start slowly with minimal exertion and gradually increase the amount of exercise you do. Allow time for your body to recover from exercise sessions to avoid injuring the tendons and causing unwanted symptoms.
In combination with orthotics and stretching, rest can effectively prevent Achilles tendonitis and tendinopathy. Gently massaging the Achilles tendon can help align the tendon's healing collagen fibers. Massage can be applied lengthways along the tendon for maximum benefit. Achilles tendonitisInsertional Achilles Tendonitis: Causes, Symptoms, and TreatmentInsertional Achilles tendonitis, a type of Achilles tendonitis, refers to inflammation at the point where the Achilles tendon attaches to the heel bone. The fibers of the tendon become inflamed, leading to Achilles tendon pain and reduced mobility in severe cases.
Achilles tendonitis left untreated over a lengthy period can lead to chronic Achilles tendonitis and persistent pain. Insertional Achilles tendonitis requires suitable treatment, as it doesn't go away by itself.
Insertional Achilles Tendonitis vs. Non-Insertional Achilles Tendonitis
There are two types of Achilles tendonitis:
Insertional Achilles tendonitis
As the name suggests, this type of tendonitis occurs at the insertion point of the Achilles tendon with the heel bone. In some cases, the heel bone may protrude outwards.Non-insertional Achilles tendonitis
This affects the middle fibers of the Achilles tendon and is commonly seen in younger people who are physically active.
Causes of Insertional Achilles Tendonitis
Overusing the tendon through various activities is the leading cause of insertional Achilles tendonitis. This condition is common in those that are not physically active.
Heel spurs (bony projections into the soft tissue around the heel) are also a common cause of developing Achilles tendonitis. Discomfort arises when the bony projection grows to a point where agitation of the soft tissue occurs.
Additionally, heel bursitis commonly occurs alongside insertional Achilles tendonitis.
Symptoms of Insertional Achilles Tendonitis
The symptoms of insertional tendonitis are directly linked to the amount of repetitive stress placed on the tendon and include:
Pain at the base of the Achilles tendon, with sensitivity to touchSwelling at the attachment siteStiffness in the ankle or feeling in the tendonDevelopment of a prominent heel bone in some casesPain when stretching the Achilles tendon
Continued exercise without activity modification will exacerbate your symptoms.
Treating Insertional Achilles Tendonitis
Prevention of Achilles tendonitis is always better than treatment; however, it is not always possible. That being said, treatment of insertional Achilles tendonitis is usually conservative in mild cases of the condition, while surgery is considered in severe cases. A complete rupture of the Achilles tendon will definitely require surgery.
Non-surgical management strategies are preferred in most cases, including:
Take some time to rest from exercises or activities that may cause flare-ups. If pain is worsened by exercise, stop the activity immediately and allow time for the tendon fibers to repair themselves.
Only resume physical activity when pain has subsided entirely for about six weeks or under the advice of a medical professional. Then, gradually increase activity and limit the duration and intensity until you are fully accustomed. Failing to do this may cause another flare-up of Achilles tendonitis, which will be even worse the second time.
Anti-inflammatory medication can be extremely helpful in managing the symptoms of those conditions in the acute phase.
Applying ice to the area is important in reducing inflammation in the tendon and lessening your pain and swelling. Ice can be applied for 15–20 minutes at a time, several times a day, and is usually recommended in the acute phase for the first two days.
An orthotic with a slight heel raise can be beneficial in reducing the tension placed on the tendon while on your feet. Orthotics for Achilles tendonitis help alleviate your symptoms, prevent ongoing pain, and limit complications arising in the future.
How long you have to wear orthotics will depend on your individual condition; however, it is usually a long-term treatment.
Gently stretch the length of the leg from the calf muscle to the Achilles tendon, allowing the collagen fibers to heal in correct alignment. Stretching can be done on a step, in various yoga poses, or against a wall. Hold the stretch for 20–30 seconds to allow the tissue to lengthen, provided there is no heel pain when stretching.
A physical therapist can provide you with a treatment strategy to target this condition, using various treatment modalities and exercise therapy for your Achilles tendon. Your physical therapist can advise you on whether it is safe to return to sporting or exercise activities without the risk of worsening the condition.
Does Insertional Achilles Tendonitis Heal Permanently?
In mild forms of the condition, rest in combination with conservative treatments can alleviate symptoms of this condition entirely. Severe cases may become chronic and lead to the lengthy, ongoing presence of symptoms that might require more drastic treatment methods.
Even with the correct treatment, recovery from insertional Achilles tendonitis is a very slow process, taking six months to a year to heal fully. Once the Achilles tendon has been injured, there is a greater likelihood of developing further tendon injuries in the future, so you should take precautionary measures. Achilles tendonitisPreventing Achilles Tendonitis: 5 Strategies That Are Vital to KnowAchilles tendonitis is a common cause of pain in the lower limbs, especially among runners. The condition occurs when the Achilles tendon becomes inflamed and is often associated with overuse.
There are means to treat this type of Achilles tendon pain, but prevention is far better. Unfortunately, complete prevention of Achilles tendonitis may be impossible. What you can do is reduce your chances of developing this foot condition.
5 Ways to Prevent Achilles Tendonitis
There are several ways to help prevent Achilles tendonitis in runners, which include:
Ensure you warm up properly to prep your muscles for action before any activity. It helps to start slowly and gradually increase the intensity and duration of the exercise or training.Wearing the right shoes
Always choose the most sports-appropriate shoes or simple shoes with proper arch support and cushioning. These properties will reduce strain on the Achilles tendon.
You can insert orthotics for Achilles tendonitis in your shoes. Such insoles will provide firm arch support and extra cushioning, reducing pressure on the foot. One orthotic device that is particularly effective is a heel cup to help Achilles tendonitis.Exercising regularly
Exercises for tendonitis are essential. Your range of exercises should include stretching and strengthening exercises for the calf muscles and plyometric and balance exercises for the body. They’ll help you better manage the strain that comes with your activities. Cross-training
Alternate between high-impact activities, like running and jumping, and low-impact activities such as cycling and swimming, to give your body room to adapt and accommodate the strain.Close monitoring
Watch how you exercise when you’re on medication like fluoroquinolones.
Risk Factors for Achilles Tendonitis
You should be extra vigilant if you have any of the risk factors below that predispose you to the condition.
Some of the main risk factors include:
It is most common in males.Age
It occurs more frequently in people who are 30 and older.Physical or structural problems
Tight or weak calf muscles, flat feet, heel spurs, and excess body weight can all contribute to an increased risk of Achilles tendonitis.Medical conditions
Conditions like diabetes, hypertension, and psoriasis can increase your risk.Medications
Those taking fluoroquinolones (a type of antibiotic) are at a greater risk of developing Achilles tendonitis.Improper training
Inadequate warm-up, cold weather, inappropriate footwear, training on uneven surfaces, and sudden increase in exercise intensity can predispose you to Achilles tendonitis.
Signs and Symptoms of Achilles Tendonitis
Quick management and treatment of Achilles tendonitis are essential to avoid unnecessary complications. To do this, you need to recognize the first signs and symptoms of injury.
The following are common symptoms of Achilles Tendonitis:
Mild, aching pain above the heel is a cardinal sign of Achilles tendonitis. The pain is typically palpable but worsens with activities. Warmth, swelling, stiffness, soreness, and thickening of the Achilles tendonLimited range of motion, causing difficulty walking and standing on your toesThere may also be heel spur formation with insertional tendonitis (injury of the Achilles tendon at its point of attachment to the heel bone).
Ensure you consult a medical practitioner for an accurate diagnosis and treatment advice as soon as you notice any of these signs or symptoms.
Complications Associated With Achilles Tendonitis
Achilles tendonitis can lead to complications if not managed early enough. Again, running with Achilles tendonitis can often worsen the condition.
Some of the possible complications of Achilles tendonitis are:
Achilles tendon rupture
Tendonitis weakens the Achilles tendon, making it prone to a rupture. You may have ruptured the Achilles tendon if you experience any of the symptoms above, along with a sudden pop in your calf or heel. An Achilles tendon rupture is a medical emergency and may need surgery to correct.Abnormal gait
Achilles tendonitis makes movement difficult, and the heel pain may change your posture. Over time, if the pain is not well managed, the adjusted posture may become your default, leading to an abnormal gait.Nodules
If the tendon degeneration progresses, nodules may begin to form in the heel.
Achilles tendonitis can take weeks to months to heal, so it's best to address it in its early stages of development, long before it becomes a problem. You can position yourself for a healthier and safer experience as you run by training and exercising appropriately.
Remember to consult your healthcare professional to ascertain the best line of treatment and to recommend additional treatment approaches if need be.
Achilles tendonitisPeroneal Tendonitis Exercises & Stretches to Relieve SymptomsPeroneal tendonitis, a common cause of lateral ankle pain, is related to inflammation arising in the lateral peroneal muscles. Inflammation occurs due to the increased load and overuse of the tendons in the lower leg, commonly seen in runners whose ankles turn inward or overpronate as the foot strikes the ground. The outward roll of the foot while running places increased strain on the peroneal muscles, eventually leading to pain and inflammation arising in the area.
Symptoms and Causes of Peroneal Tendonitis
Symptoms of peroneal tendonitis include:
Direct and localized pain along the length of the tendonSwelling or redness around the tendon Pain that worsens with activity and improves with restThickened tendons, seen over time
Causes of peroneal tendonitis include:
Overuse of the tendons in the lower leg Increase in activities that repetitively load the peroneal muscles Improper or old footwear, leading to increased strain placed on the peroneal muscles Biomechanical misalignment in the body
The risk factors that could lead to peroneal tendonitis include:
High foot archesWeakened lower limb muscles Improper footwear Age may increase the chances of developing this condition Tightened calf muscles Poor foot biomechanics Inappropriate training techniques
Exercises for Peroneal Tendonitis
Start by sitting on a chair and bring one leg up to rest your foot over the opposite knee. Move your foot up and down and side to side to warm up the ankle muscles. Repeat on both feet several times. Next, apply gentle resistance to the foot with your hand as you try to pull the foot inwards. Hold for 10 seconds and release. Next, push your foot outward against the resistance of your hand and hold for 10 seconds.
Standing on a soft, flat surface with support if needed, slowly rise onto the toes of both feet at the same time. Be sure to engage the calf muscles. Repeat 10–15 times
Sitting on a soft surface with your legs outstretched in front of you, wrap a towel around the toes of one foot. Pull back, gently applying a stretch to the calf and foot muscles. Hold for 20–30 seconds and repeat.
Heel raises and towel stretches can also help heal a sprained ankle.
Ankle Exercises with Elastic Bands
By using an elastic band, you can do exercises that can directly target the perineal muscles of the lower leg. Start by sitting with your legs out in front of you, placing the elastic band around the forefoot of one foot. Pull the foot inwards while trying to maintain normal alignment of the foot. This will engage the peroneal muscles of the leg. Contract and hold for 5 seconds, then relax. Repeat on the other leg.
Please note that exercises should not cause pain during or after exercise. Be sure to rest if you experience pain or inflammation.
Preventing Peroneal Tendonitis
Peroneal tendonitis can be prevented by using proper supportive footwear and arch supports throughout the day to minimize pressure on the peroneal tendons as you walk or run. Supportive shoes that prevent the outward roll of the foot should help prevent ankle pain when walking or running.
Rest, Ice, and Elevation
Rest will alleviate symptoms of peroneal tendonitis and allow inflammation in the tendon to reduce before going back to your regular exercise. Ice can also be applied alongside elevating the ankle to reduce pain and inflammation in the area further.
Stretching can have significant benefits in maintaining the alignment of the collagen fibers as they heal in the peroneal tendons and muscle fibers.
Medication can be prescribed by a medical professional to help you manage pain and inflammation. Anti-inflammatory drugs, such as ibuprofen and diclofenac, will greatly improve these symptoms.
You can gently massage the area along the tendon where the pain is located using a topical analgesic gel or lotion to relieve pain. The massage also brings blood to the area, promoting the healing of the tissue.
A physical therapist will be able to guide you through the rehabilitation process and other treatment modalities that could help you heal and return to sport safely.
How Long Is Recovery From Peroneal Tendonitis?
Recovering from peroneal tendonitis can take a fair amount of time. It can take 6–8 weeks to improve with limited activity.
Surgical intervention is rare but not uncommon. It is usually a last resort if all conservative management strategies have failed to manage pain. Scar tissue around the tendon that has developed through countless healing processes should be surgically removed to ensure smooth gliding of the tendon. Please consult with a medical professional regarding starting exercise therapy after surgery.
Sometimes sudden ankle pain can occur due to different types of ankle sprains or even ankle arthritis. If you're unsure about the cause of your ankle pain, take a look at the ankle pain symptom checker. Achilles tendonitisAchilles Tendonitis: Symptoms, Causes, Treatments, and MoreThe Achilles tendon is the band of tissue that connects the calf muscles in the lower limb to your heel bone. When this tissue becomes inflamed, the result is Achilles tendonitis, an overuse injury associated with pain above the heel that is common with athletes.
This article looks at the symptoms and causes of Achilles tendonitis, different treatment options, and what you can do to reduce the risk of developing it.
Symptoms of Achilles Tendonitis
Achilles tendonitis usually causes pain at the back of the leg but can also present with pain above the heel during activities like running. It becomes more severe with high-impact activities like exercising, climbing, and sprinting. This pain is usually worse in the morning and after rest from activity.
Other symptoms include:
Difficulty walkingAnkle stiffnessTightness in the tendonSwellingHeat around the tendon
Causes of Achilles Tendonitis
While the primary cause of Achilles tendonitis is overuse, several risk factors can predispose you to the injury. Some of the most are:
Achilles tendonitis is more common in men than women.
Degenerative changes occur to the Achilles tendon with age, making older people more likely to develop Achilles tendonitis.
A flat arch and tight calf muscles can predispose you to Achilles tendonitis, as well as obesity.
Running with worn-out shoes or shoes that provide little support can increase the chances of developing Achilles tendonitis.
Uneven surfaces can cause inflammation and lead to pain, tenderness, and swelling of the Achilles tendon.
Conditions like psoriasis or high blood pressure put you at a greater risk of developing Achilles tendonitis.
Quinolones and Fluoroquinolones (antibiotic medications) have been associated with incidences of Achilles tendon ruptures in the past.
Treatment of Achilles Tendonitis
Treatment must be administered to the ankle as soon as possible once Achilles tendonitis is observed. The treatment aims to reduce the tension on the tendon, which is usually done in the following ways:
The RICE Method (Rest, Ice, Compression, Elevation)
An initial period of rest is necessary for healing to take place. Where this is not possible, limit activity so that only the minimum load possible is transmitted through the leg. Applying ice will help deal with inflammation in the acute phase. With compression stockings, you can increase blood flow to the area and speed up tendon healing. Lastly, elevation also encourages decreased inflammation.
Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can be used to decrease pain and inflammation. Unlike posterior tibial tendonitis (PTTD), corticosteroid injections are not recommended for Achilles tendonitis as they can cause the tendon to rupture.
Strengthening and stretching exercises for the Achilles tendon are useful exercises to treat Achilles tendonitis. The stronger the muscles are, the less work the tendon will have to do. The less the load it bears, the lesser the pain that may result.
Some basic stretches are the Achilles tendon stretch, calf stretch, and plantar fascia stretch. The strengthening exercises will mostly be eccentric exercises of the Achilles tendon, gastrocnemius, and soleus muscles, thereby reducing any further risk of calf strain or worsening tendonitis.
Orthotics can help redistribute the pressure in the foot and consequently the amount of tension in the Achilles tendon. Likewise, heel lifts can be used temporarily to take some load off the Achilles tendon. Where it is used for a prolonged period, it can cause a shortening of the tendon.
Surgery is considered a last resort when the non-invasive methods have been tried without commensurate results. However, where it is a total rupture, surgical repair is necessary within a few days of the injury.
How to Reduce the Risk of Achilles Tendonitis
While total prevention may be impossible, you can limit the risk of Achilles tendonitis by:
Using appropriate footwear
Footwear that is properly fitted, cushioned, and provides adequate support.
Warm up properly before exercise
Do not increase the duration or intensity of your exercise without a proper warm-up. Once done, avoid stopping the exercise abruptly too.
Maintain a healthy body weight
Excess weight increases the load on the Achilles tendon.
Be aware of acute symptoms
If you notice any sudden pain around your heel, rest from exercise, and seek the expert opinion of a podiatrist as soon as possible.
Achilles Tendonitis Management
It takes time to recover from any injury to the Achilles tendon. The actual length of recovery is dependent on the severity of the injury and the promptness/compliance with treatment. Where intervention is prompt and strictly adhered to, return to pre-tendonitis state is possible within 12-16 weeks.