Achilles Pain

Is Achilles pain making those first few steps in the morning uncomfortable, or stopping you from enjoying your usual walks and activities?

Perhaps you've noticed a sharp or aching pain at the back of your heel when getting out of bed, climbing stairs or walking uphill. You might find that the discomfort improves once you start moving, only to return later in the day or after exercise.

For others, the pain may be accompanied by swelling, tenderness or a feeling of tightness running from the heel towards the calf.

Whether you're someone who enjoys regular exercise or simply wants to get through the day without constantly thinking about your heel, Achilles pain can become surprisingly disruptive.

But what exactly is causing the discomfort?

Although Achilles tendonitis is a common cause, pain around the Achilles tendon can also be associated with heel bursitis, tendon degeneration or other injuries. Understanding the difference is important because the most appropriate treatment depends on which structures are affected.

In this article, we'll explain the common causes of Achilles pain, the symptoms to watch for and the different treatment options available. We'll also discuss where OSMO Patch may offer a drug-free, non-invasive option to help manage swelling and associated pain around the heel.

Understanding Achilles Pain

The Achilles tendon is the large, strong band of tissue running down the back of your lower leg, connecting your calf muscles to your heel bone.

It's responsible for helping you push off the ground when walking, running, jumping or rising onto your toes. In fact, almost every step you take places some degree of load through this important tendon.

Although the Achilles tendon is designed to tolerate substantial forces, repeated strain or sudden increases in activity can sometimes exceed its ability to cope.

When this happens, pain may develop within the tendon itself or in the surrounding tissues.

Achilles pain isn't a diagnosis in its own right. It's a general description of discomfort around the Achilles tendon, and several different conditions may be responsible. [1]

What Are the Most Common Causes of Achilles Pain?

One of the first things to establish is exactly where the pain is coming from.

Although different conditions can produce similar symptoms, the location of the discomfort and the activities that aggravate it can provide useful clues.

1. Achilles Tendonitis or Tendinopathy

Achilles tendonitis is one of the most common causes of pain at the back of the heel and ankle.

The condition develops when the Achilles tendon becomes irritated, often because of repeated loading or a sudden increase in physical activity.

However, there's an important distinction worth understanding.

While the term tendonitis refers to inflammation of a tendon, longer-standing Achilles problems often involve changes within the tendon fibres rather than inflammation alone.

These conditions are frequently described as Achilles tendinopathy.

There are two main types of Achilles tendinopathy, based on the location of the affected tendon.

Midportion Achilles Tendinopathy

This affects the middle section of the tendon, generally a few centimetres above its attachment to the heel bone. The tendon may feel tender or thickened, and discomfort often increases during walking, running or other weight-bearing activities.

Insertional Achilles Tendinopathy

This affects the lower section of the tendon, where it attaches directly to the heel bone. Pain is generally concentrated closer to the back of the heel and may be aggravated by footwear, walking uphill or movements that place additional compression around the tendon attachment.

Both conditions can cause stiffness, tenderness and pain during everyday activities. [2]

2. Achilles Bursitis or Heel Bursitis

Another common cause of pain around the Achilles tendon is heel bursitis.

Around the back of the heel are small cushioning sacs called bursae, which help reduce friction between neighbouring tissues.

When one of these bursae becomes inflamed, it can cause localised swelling, tenderness and pain. [4]

In some cases, the discomfort becomes particularly noticeable when wearing enclosed shoes or placing pressure against the back of the heel.

For a more detailed explanation of the different types of heel bursitis, including common symptoms and treatment options, read our Achilles Bursitis Information article.

3. Retrocalcaneal Bursitis

Retrocalcaneal bursitis is a specific type of Achilles bursitis that affects the deep cushioning sac located between the Achilles tendon and the heel bone.

Because this bursa sits in a confined space, movements that bend the ankle upwards can increase compression around the affected tissues.

As a result, activities such as walking uphill, climbing stairs or certain calf stretches may become particularly uncomfortable.

Retrocalcaneal bursitis can also occur alongside insertional Achilles tendinopathy, making it difficult to distinguish between the two conditions without a proper examination.

You can learn more about the location, causes and symptoms in our Retrocalcaneal Bursitis Information article.

4. Achilles Tendon Injuries or Tears

Not all Achilles pain develops gradually.

Sometimes a sudden movement, awkward landing or unexpected increase in force can cause a partial or complete tear of the Achilles tendon.

A complete rupture may produce a popping sensation, sudden severe pain or difficulty pushing off the affected foot.

Unlike the more gradual discomfort associated with tendinopathy or bursitis, a suspected Achilles tendon rupture requires urgent medical assessment.

What Are the Symptoms of Achilles Pain?

The symptoms you experience will depend on which part of the Achilles tendon or surrounding tissues is affected.

Some people notice discomfort only during exercise, while others experience pain when walking, getting out of bed or simply wearing certain shoes.

Common symptoms include:

• Pain at the back of the heel: Particularly around the Achilles tendon attachment.

• Morning stiffness: Discomfort during the first few steps after getting out of bed.

• Tenderness along the tendon: The affected area may be painful when touched or pressed.

• Swelling or thickening: The tendon or surrounding tissues may appear enlarged.

• Pain during activity: Walking uphill, running, jumping or climbing stairs may aggravate symptoms.

• Discomfort after exercise: Pain may become more noticeable later in the day or the following morning.

• Reduced strength or movement: Particularly when attempting to rise onto your toes or push off while walking.

One frustrating feature of Achilles tendinopathy is that the discomfort may ease temporarily once you start moving, giving you the impression that the problem has improved.

However, if the tendon is being subjected to more strain than it can tolerate, the pain may return afterwards.

Why Does My Achilles Hurt First Thing in the Morning?

If you're experiencing Achilles tendon pain, you may have noticed that the first few steps after getting out of bed are particularly uncomfortable.

After several hours of rest, an irritated tendon can feel stiff and less comfortable when it is first loaded.

As you begin moving, the stiffness may ease, allowing you to walk more comfortably.

However, the fact that your Achilles feels better after warming up doesn't necessarily mean the underlying problem has resolved.

You may find that the discomfort returns after a longer walk, climbing stairs or spending extended periods on your feet.

Morning stiffness is a common feature of Achilles tendinopathy, although it can also occur with other conditions around the heel. [1][2]

Why Does Achilles Pain Develop?

Achilles pain often develops when the demands placed on the tendon or surrounding tissues exceed their ability to tolerate repeated strain.

This can happen gradually or after an unexpected change in activity.

Several factors may contribute.

Sudden Increases in Physical Activity

Perhaps you've recently started walking longer distances, returned to running after a break or taken up a new exercise program.

Increasing the intensity or duration of activity too quickly can place additional stress on the Achilles tendon before it has had sufficient time to adapt.

Repetitive Strain and Insufficient Recovery

The Achilles tendon is used repeatedly throughout the day, particularly during walking and other weight-bearing activities.

When strenuous activity is repeated without adequate recovery, discomfort may begin to develop.

Calf Muscle Weakness or Tightness

Your calf muscles work closely with the Achilles tendon to control movement through the ankle.

Reduced calf strength or limited ankle movement may affect how forces are distributed through the tendon.

Footwear and Walking Mechanics

Poorly fitting shoes, inadequate support or sudden changes in footwear can sometimes contribute to irritation around the heel.

Your walking or running mechanics may also influence how much load is placed on the Achilles tendon.

Age and Other Health Factors

Although Achilles injuries are commonly associated with athletes, they can affect people of all ages and activity levels.

Age-related tendon changes, certain medical conditions and some medications may increase susceptibility to tendon problems. [1]

How Is the Cause of Achilles Pain Diagnosed?

Because several conditions can cause pain behind the heel, it's important to establish which tissues are involved before deciding on treatment.

A healthcare professional will generally begin by discussing your symptoms, when they first developed and which activities aggravate the discomfort.

They may examine the Achilles tendon, assess ankle movement and check for tenderness, swelling or changes in tendon thickness.

Depending on your symptoms, they may also assess your ability to stand on your toes or perform other movements that place load through the tendon.

In many cases, a clinical examination provides sufficient information to make an initial diagnosis.

However, further investigations may sometimes be recommended.

Ultrasound: Can help assess the Achilles tendon and identify thickening, structural changes or surrounding fluid.

MRI Scan: May be useful when a more detailed assessment is needed, particularly if a significant tendon injury is suspected.

X-rays: Can help identify bone-related changes, such as a prominent heel bone or calcification around the tendon attachment.

Imaging isn't always necessary, but it may help when the diagnosis remains uncertain or symptoms aren't improving.

What Are the Treatment Options for Achilles Pain?

If you've been struggling with Achilles pain, your first priority is understandably to find some relief.

However, because the discomfort may originate from the tendon itself or from surrounding structures such as an inflamed bursa, treatment should be tailored to the underlying cause.

1. Rest and Activity Modification

Reducing activities that aggravate your Achilles is often an important first step.

If running, climbing hills or walking longer distances consistently increases your discomfort, those activities may need to be temporarily reduced or avoided.

However, prolonged complete rest isn't generally recommended for most cases of Achilles tendinopathy.

The tendon needs an appropriate amount of loading to maintain and rebuild its strength.

The aim is to avoid activities that overload the injured tissues while maintaining comfortable movement and gradually restoring your ability to tolerate everyday activities.

If bursitis is contributing to the pain, exercises that irritate the affected bursa should be avoided. Any continued exercise should be carefully tailored to prevent unnecessary stress or compression around the affected heel.

2. Cold and Heat Therapy

During the first 48–72 hours following a new injury or acute flare-up, cold therapy may help manage swelling, inflammation and pain.

Applying a cold pack wrapped in a towel for approximately 10–20 minutes at a time may provide temporary relief. Cold can also be useful if the affected area becomes irritated again following physical activity.

Once the initial swelling and acute irritation have settled, gentle heat may be more appropriate for managing ongoing stiffness or tightness around the calf and ankle.

Warmth helps increase local blood circulation and may improve comfort by relaxing the surrounding muscles.

However, avoid applying heat directly over an area that remains noticeably hot, red or significantly swollen.

3. Footwear and Heel Support

Sometimes, small changes to your footwear can make everyday activities more comfortable.

Shoes with appropriate cushioning and support may help reduce unnecessary strain, while a softer heel counter can be particularly useful when the back of the heel is sensitive to pressure.

A podiatrist or physiotherapist may also recommend a temporary heel lift or suitable insole, depending on the underlying condition.

However, footwear changes should be selected according to the location and cause of your Achilles pain.

4. Physiotherapy and Rehabilitation

Physiotherapy is an important part of treatment for many persistent Achilles tendon problems.

Rather than relying on rest alone, rehabilitation generally involves gradually restoring the tendon's ability to tolerate normal physical activity. [3]

Depending on your condition, a physiotherapist may recommend exercises designed to improve calf strength, ankle movement and overall lower-limb function.

However, not every exercise is suitable for every Achilles condition.

For example, certain heel-drop exercises may be appropriate for midportion Achilles tendinopathy but can aggravate insertional Achilles pain or retrocalcaneal bursitis by increasing compression around the heel.

This is why exercises should be tailored to the diagnosed condition, rather than assuming that stretching or strengthening harder will necessarily help. [2]

5. Medication and Other Medical Treatments

Pain-relieving medication may sometimes be recommended to help manage discomfort.

Anti-inflammatory medication can be useful in selected cases, although persistent Achilles tendinopathy isn't always primarily an inflammatory condition.

Corticosteroid injections directly into the Achilles tendon are generally avoided because of the risk of weakening the tendon and potentially contributing to rupture.

Other treatments, including shockwave therapy, may be considered in certain persistent cases.

Surgery is generally reserved for selected conditions that haven't responded to an appropriate course of conservative treatment. [2]

6. Drug-Free Heel Swelling Relief with OSMO Patch

If Achilles pain is accompanied by swelling and associated discomfort, OSMO Patch may offer a drug-free, non-invasive home treatment option to help manage these symptoms while you sleep.

Developed in Australia and trusted for over 15 years, OSMO Patch is applied externally over the affected area before going to bed, following the supplied application instructions.

It may be considered alongside appropriate rest, activity modification and rehabilitation.

However, it's important to recognise that persistent Achilles tendinopathy doesn't always involve significant swelling, and OSMO Patch isn't intended to repair damaged tendon fibres or treat an Achilles tendon rupture.

For people diagnosed with heel bursitis, where inflammation and swelling around the cushioning tissues may contribute to the discomfort, OSMO Patch offers a practical option for helping manage these symptoms.

Looking for a drug-free, non-invasive way to help manage swelling and associated pain around your heel?

→ Discover OSMO Patch for Heel Bursitis Treatment

(ALWAYS FOLLOW THE DIRECTIONS FOR USE. Not suitable for individuals with seafood or shellfish allergies)

How Long Does Achilles Pain Take to Heal?

Recovery times depend on the underlying cause, how long symptoms have been present and whether the Achilles tendon or surrounding bursae are affected.

Some mild injuries may improve within several weeks after reducing aggravating activities and receiving appropriate treatment.

However, persistent Achilles tendinopathy can take several months to improve, particularly when the tendon has been subjected to repeated strain over an extended period.

Heel bursitis may also take longer to settle when repeated compression, footwear pressure or another underlying problem continues irritating the affected tissues.

Using OSMO Patch alongside adequate rest and avoiding activities that irritate the affected area may help support the recovery process where swelling and associated pain are present. OSMO Patch is designed to provide relief from these symptoms while appropriate treatment and rehabilitation address the underlying condition.

It's worth remembering that feeling less pain doesn't necessarily mean the tendon or surrounding tissues have fully recovered.

Returning too quickly to strenuous exercise may aggravate symptoms, so any increase in activity should be gradual and appropriate to the condition being treated.

 

Frequently Asked Questions About Achilles Pain

Why Does My Achilles Hurt When I First Get Out of Bed?

Morning pain and stiffness are common symptoms of Achilles tendinopathy.

After a period of rest, the tendon may feel uncomfortable when it is first loaded. As you begin moving, the stiffness may ease, although the discomfort can return later after activity.

Persistent morning Achilles pain should be assessed to establish the underlying cause.

Is Achilles Pain Always Caused by Tendonitis?

No. Although Achilles tendonitis or tendinopathy is a common cause, pain around the Achilles tendon can also be associated with heel bursitis, retrocalcaneal bursitis or other injuries.

The location of the pain and the activities that aggravate it may provide clues, but an accurate diagnosis is important before choosing treatment.

Can I Keep Walking if My Achilles Is Painful?

Gentle walking may be appropriate if it doesn't significantly aggravate your symptoms.

However, longer distances, hills or repeated stair climbing can place additional strain on the Achilles tendon and surrounding tissues.

If you're experiencing bursitis, activities that irritate the affected area should be avoided. If you wish to continue exercising, activities should be tailored to avoid unnecessary stress or compression.

Does Swelling Around My Achilles Mean I Have Bursitis?

Not necessarily.

Swelling can occur with Achilles tendinopathy, bursitis and other soft-tissue injuries.

Bursitis may produce localised swelling around the back of the heel, while tendon problems can cause thickening or swelling along the Achilles tendon itself.

A healthcare professional can help determine which structures are affected.

When Should I Be Concerned About Achilles Pain?

Seek urgent medical attention if you experience a sudden popping sensation, severe pain following an injury or difficulty pushing off your foot, as these symptoms may indicate an Achilles tendon rupture.

You should also arrange a medical assessment if the pain is persistent, worsening or interfering significantly with your everyday activities.

Increasing redness, warmth or swelling accompanied by fever requires prompt assessment.

 

When Should You Seek Medical Attention?

Although many causes of Achilles pain improve with appropriate conservative treatment, persistent symptoms shouldn't be ignored.

If your pain continues despite reducing aggravating activities, or you're experiencing recurring swelling, stiffness or difficulty walking, consult a qualified healthcare professional.

A proper diagnosis can help identify whether the discomfort is coming from the tendon, an inflamed bursa or another structure around your heel, allowing an appropriate treatment and rehabilitation plan to be developed.

Seek urgent medical attention if you experience sudden severe pain, hear or feel a pop near your Achilles tendon, or suddenly find it difficult to push off your foot. These symptoms may indicate an Achilles tendon rupture.

Medical References

[1] Healthdirect Australia: Achilles Tendon Injuries – Causes, Symptoms and Treatment. Read the Healthdirect medical guidance

[2] American Academy of Orthopaedic Surgeons (AAOS): Achilles Tendinitis – Symptoms, Diagnosis and Treatment. Read the AAOS medical reference

[3] NHS Inform: Achilles Tendinopathy. Read the NHS medical guidance

[4] Merck Manual: Achilles Tendon Bursitis. Read the Merck Manual medical reference