Achilles Tendonitis Treatment in Amman

What is Achilles tendinopathy?

The Achilles tendon is a strong tendon that joins the calf muscles to the heel bone and works with every step, jump and rise onto your toes. When the tendon takes more load than it is used to, such as a sudden increase in running or jumping or a change in training, it can become irritated, weaker and painful. Medically this is called Achilles tendinopathy, and many people call it tendonitis. The pain is in one of two places: the middle of the tendon a little above the heel, or where the tendon attaches to the heel bone, and treatment differs between them in some details. It affects both sporty and non-sporty people, and it is common in runners.

Common signs

Pain at the back of the ankle above the heel, or where the tendon attaches to the heel bone
Pain that increases with activities that load the tendon, such as running, jumping, climbing stairs and rising onto your toes
Tenderness when pressing on the tendon, which may look thicker than the tendon on the other leg
Stiffness in the tendon and a weaker push-off when walking or running

Common misunderstandings

"Complete rest is the answer": complete rest is not usually advised; it is better to stay active within a tolerable level of pain while temporarily easing what irritates the tendon
"Any pain during exercise means I am damaging the tendon": a tolerable amount of pain during exercise is often acceptable; we watch how the tendon responds afterwards and adjust the load accordingly
"The changes on my scan mean the tendon will not get better": a scan alone does not predict recovery, and improvement is measured by pain and by what you can do, such as walking, running and sport

What usually helps?

The core is progressive loading exercise for the tendon and calf muscles, such as heel raises standing on both feet and then on one, with the load increased gradually using weights or stronger movements such as light hopping, as you tolerate them. These exercises can be of different kinds: held contractions, slow lifts with heavier load, or slow lowering under load, so treatment is not limited to one type, and when pain is high we may start with lighter load. For pain where the tendon attaches to the heel, exercises usually start on flat ground, without letting the heel drop below the edge of a step. For runners, we temporarily reduce the amount and intensity of running or whatever irritates the tendon, replace it with activity that does not increase pain, then bring running back gradually. A heel lift in the shoe may help for a while, and taping or manual therapy may ease pain as part of the plan, although the evidence for them is limited. If things do not improve despite a regular programme over a reasonable period, other options such as shockwave therapy or injections may be considered; decisions about injections and surgery belong to the doctor, and caution is usually advised with steroid (cortisone) injections in or around the tendon.

How we treat it at Revibe

We listen: when the pain started, what has changed in your training, running, work or footwear, and which medicines you take
We examine the tendon and where it hurts, calf strength and endurance, ankle movement and walking, and recognise what needs a doctor or imaging, such as a suspected tendon tear or an inflammatory joint condition
We identify what keeps the tendon irritated, such as a sudden rise in load, weak calf muscles or the way you train
We treat: progressive loading exercise is the core of the plan, and manual therapy, release of muscle knots in the calf or dry needling of the calf muscles may be added when suited, although the evidence for these extras is limited
We progress with a home exercise programme and a plan for managing load, then a gradual return to running, jumping and sport

When do you need urgent medical care?

Calf pain or swelling with sudden shortness of breath or chest pain — go to the emergency department or call an ambulance: 911 in Jordan or 122 in Iraq and Kurdistan
A sudden snap, or a feeling of being kicked or hit at the back of the ankle or calf, followed by difficulty pushing off, walking or rising onto your toes: the tendon may have torn — go to the emergency department the same day
Pain, swelling and warmth in one calf only (could be a clot) — see a doctor the same day
A hot, red, swollen tendon or heel with a fever — see a doctor the same day
Tendon pain that started while taking a type of antibiotic called a fluoroquinolone, such as ciprofloxacin or levofloxacin — tell the doctor who prescribed it straight away

In these cases go to the nearest emergency department or a doctor straight away — instead of booking physiotherapy.

FAQ

Should I stop running?

Usually we do not stop everything. We temporarily reduce the amount and intensity of running or swap it for activity that does not increase pain, keep up the loading exercises, then bring running back gradually as the tendon responds, because returning to full load too quickly may make the pain more likely to come back.

Do I need a scan or an MRI?

In most cases, no. Diagnosis usually rests on your story and the examination; imaging, most often ultrasound, is requested when the diagnosis is unclear or a tear is suspected, when recovery is slower than expected, or before another procedure is considered.

Do I need an injection or surgery?

In most cases the plan starts with exercise and managing load. If things do not improve despite a regular programme over a reasonable period, the doctor may discuss other options with you, and decisions about injections and surgery are the doctor’s. Caution is usually advised with steroid injections in or around the tendon.

How many sessions will I need?

It depends on your condition and how long you have had it; after the first assessment we explain the plan and the expected number of sessions.

More common questions: Foot and ankle questions — 27 questions