Sore Achilles After Running: Causes, Treatment & Prevention

Achilles tendinitis is a frequent source of heel pain in both athletes and active adults. The Achilles tendon, which connects the calf muscles to the heel bone, is vital for walking, running, and nearly every weight-bearing activity. When this tendon becomes irritated or damaged, early diagnosis and expert care make a significant difference in recovery and in preventing long-term problems. At Precision Pain & Spine Institute, our board-certified specialists offer comprehensive, evidence-based care for all forms of Achilles pain.
 

What Is Achilles Tendinitis?

Achilles tendinitis is a condition that affects the strong, fibrous tendon running along the back of the ankle. This tendon allows you to push off the ground while walking, running, or jumping. It is also known as Achilles tendinopathy or “runner’s heel.” Overuse and repetitive stress are common reasons for irritation or small tears in the tendon. When left untreated, this inflammation may progress to chronic degeneration or even tendon rupture.

The Achilles tendon’s unique structure—combining muscle and fibrous tissue—enables it to handle substantial force, but also makes it susceptible to overuse injuries. The condition can affect anyone but is most common among runners, middle-aged adults, and those who suddenly increase their physical activity.

Why It Happens

Achilles tendinitis is usually caused by repetitive strain or sudden increases in physical activity. Common risk factors and triggers include:

• Overuse: Rapidly increasing running distance, speed, or frequency without proper conditioning can lead to micro-tears and inflammation.
• Training Errors: Jumping into high-intensity hill workouts, speed sessions, or not allowing enough recovery between runs.
• Biomechanical Issues: Overpronation, heel striking, or abnormal foot mechanics add stress to the tendon.
• Muscle Imbalance: Weak or tight calf muscles (gastrocnemius and soleus) transfer extra load to the tendon.
• Footwear Problems: Worn-out or improper shoes lacking support for your gait or foot type.
• Age & Degeneration: As we age, the tendon loses elasticity and blood flow, raising injury risk.
• Medical Factors: Some antibiotics (such as fluoroquinolones), metabolic disorders, and chronic diseases may weaken tendon tissue.

Weekend warriors, new runners, and those returning from injury are particularly vulnerable if they skip warm-ups or do not build up activity gradually.

Signs & Symptoms

Achilles tendinitis can present with a variety of symptoms, which often develop gradually. Key signs include:
 

• Pain and stiffness at the back of the heel or lower calf, worse after running or on waking in the morning
• Swelling or thickening along the tendon, sometimes with a noticeable “bump”
• Tenderness to touch above the heel, especially during or after activity
• Limited ankle movement or pain with dorsiflexion (pulling foot upward)
• Difficulty pushing off on the toes, especially when climbing stairs or running uphill
• Red flags: Sudden, severe pain, inability to bear weight, or hearing a “pop”—these may signal a complete tendon rupture and require immediate medical attention

Recognizing symptoms early allows for effective, non-surgical management and reduces the risk of chronic damage.

Diagnosing Achilles Tendinitis

Diagnosis begins with a comprehensive evaluation by a pain specialist, podiatrist, orthopedic physician, or sports medicine expert. During your first visit, you can expect:
 

• Medical history review: Your doctor will discuss your activity levels, training routine, and previous injuries.
• Physical examination: Assessment of the tendon for swelling, thickening, warmth, tenderness, and range of motion.
• Functional tests: You may be asked to walk, stand on tiptoes, or perform calf raises.
• Imaging: Ultrasound is frequently used to assess tendon structure and inflammation. MRI may be needed to rule out significant tears or chronic degeneration.
• Electrodiagnostic studies (EMG): Rarely used, but helpful if there is concern for nerve involvement or atypical pain patterns.

Most cases are diagnosed with a combination of clinical exam and imaging. Early and accurate diagnosis is the foundation for successful recovery.

Treatment Options

1. Conservative Care

Activity modification: Rest from high-impact activities, substituting with low-impact exercise (cycling, swimming) if needed.
RICE Protocol: Rest, Ice, Compression, Elevation in the initial phase to manage swelling and pain.
Anti-inflammatory medications: Short-term use may relieve symptoms but should be guided by a physician.
Physical therapy: Calf stretching, eccentric strengthening exercises, balance work, and gradual loading protocols are essential for healing. Therapists may use manual therapy or modalities to reduce pain and promote flexibility.
Custom orthotics or heel lifts: These help offload the tendon and correct foot alignment, especially for those with flat feet or abnormal gait.
Chiropractic care: Addresses mechanical dysfunction, improves posture, and may alleviate associated muscle tension.

2. Image-Guided and Regenerative Procedures

Platelet-rich plasma (PRP) or corticosteroid injections: Recommended for cases unresponsive to conservative management. PRP may promote tendon healing, while steroid injections reduce inflammation.
Shockwave therapy: Used for persistent, chronic cases to stimulate repair and decrease pain.

3. Surgical Fixes

Reserved for full ruptures or chronic degeneration that fails all non-surgical treatments. Surgery may involve tendon repair, debridement, or augmentation. This option is considered only after exhausting conservative and advanced nonsurgical care.

Living With Achilles Tendinitis

Living with Achilles tendinitis requires thoughtful adjustments and attention to daily habits:

• Adopt daily stretching and strengthening routines for calves and ankles.
• Wear appropriate footwear with good heel support—replace shoes every 300–500 miles or when worn.
• Use orthotics or heel lifts as prescribed, especially if you have persistent pain or structural issues.
• Monitor activity levels: Gradually resume walking and running as symptoms permit; avoid returning to full intensity until cleared by a clinician.
• Apply ice after activity to manage discomfort.
• Focus on overall health: Sleep well, eat a balanced diet rich in nutrients that support tissue repair, and address mental health concerns such as anxiety or frustration during rehabilitation.
• Stay connected to care: Maintain regular follow-up with your provider to adjust your plan as you progress.

Prevention Tips

• Warm up and stretch before and after physical activity.
• Progress gradually: Increase running distance and speed no more than 10% per week.
• Cross-train with activities that reduce repetitive tendon strain, like cycling or swimming.
• Strengthen the lower legs and feet—target both flexibility and power.
• Replace shoes regularly and use pairs suited to your foot mechanics and running style.
• Monitor for early warning signs of tendon soreness and address them promptly to avoid more serious injury.
• Have a biomechanical assessment if you experience recurrent pain or participate in high-impact sports.

How We Can Help

At Precision Pain & Spine Institute, your care team includes board-certified podiatrists, orthopedic surgeons, pain management doctors, sports medicine experts, and chiropractors. We provide advanced diagnostics (including ultrasound and MRI), the latest image-guided treatments, and physical therapy—offering coordinated, multidisciplinary care. With same-week appointments, on-site procedures, and personalized recovery plans, we help patients return to full activity safely and confidently.
Book your appointment for a prompt, thorough evaluation and tailored treatment plan.

Frequently Asked Questions

1. How long does Achilles tendinitis last?

Most mild to moderate cases improve in four to eight weeks with proper care. More severe or chronic cases may take several months.

2. Can I continue running with Achilles pain?

If pain is mild and resolves quickly, gentle activity may be safe, but persistent or worsening symptoms require a pause from running and professional evaluation.

3. Are orthotics helpful for Achilles pain?

Yes, custom orthotics can support proper foot alignment and reduce strain on the Achilles tendon, aiding both treatment and prevention.

4. Is imaging always required?

Not always. Most cases are diagnosed through exam, but imaging (ultrasound, MRI) is important if severe injury or rupture is suspected.

5. When should I see a specialist?

If pain persists for more than two weeks, is severe, or you are unable to walk, see a specialist promptly to prevent serious complications.