How is Achilles Tendon Pain Diagnosed?


If you think you are experiencing Achilles tendon pain, you will probably want to visit a doctor. If you have concerns about an acute rupture, visit an emergency room as quickly as possible. You will probably be seen by an orthopedic specialist.

After discussing your symptoms, the doctor will perform a physical exam, including an assessment of your foot and ankle; they will inspect the area for:

  • Swelling at the Achilles tendon and the back of the heel
  • Possible bone spurs at the base of the tendon or the back of the heel, which may indicate insertional tendonitis
  • Location of the pain – pain in the middle of the tendon could be non-insertional tendonitis
  • Heel pain when stretching the calf
  • Limited range of motion of the ankle and inability to point the toes downward

After a physical exam, the doctor will order imaging tests to determine if the condition is Achilles tendonitis or another problem. These tests might include the following:

  • X-rays can provide clear images of bones; therefore, bone spurs on the back of the heel can be seen, suggesting insertional Achilles tendonitis. In cases of severe non-insertional tendonitis, calcification (calcium buildup in the tendons) can be viewed from the X-rays.
  • Ultrasound is faster and less expensive than an MRI. Additionally, it can be performed in a doctor’s office. Ultrasound can help show the quality of the tendon through different ranges of motion and gives information on thickness, swelling, and tearing.
  • MRI (Magnetic Resonance Imaging). This imaging test is typical if nonsurgical treatments have not proven effective. Depending on the severity of damage to the tendon, which can be visualized through an MRI, the doctor can plan which surgical procedure should be used.

How is Achilles Tendon Pain Treated?


Since Achilles tendon pain is considered an “overuse” condition, rest is the number one suggestion. Also, Achilles tendonitis is a soft tissue injury; therefore, following the RICE approach can offer significant relief. The RICE method includes:

  • Rest
  • Ice
  • Compression (ACE bandage)
  • Elevation of the affected area.

Additional therapies and treatments for Achilles tendon pain are:

Nonsurgical options

Doctors will first suggest nonsurgical options for treating Achilles tendon pain. They hope to fortify the tendon using exercise and strength training routines. The following the suggestions for treating soft tissue injuries may be advised. These suggestions to treat Achilles tendon injuries include:

  • Rest the injured area and avoid further strenuous activity
  • Ice the area to reduce swelling and pain
  • Compression bandages can help add support to the injured area
  • Elevate the affected leg/ankle
  • Anti-inflammatory medications will reduce swelling and alleviate some of the pain
  • Physical therapy is suggested to regain strength and movement to the area
  • Boot. If you have an acute tendon rupture, you may be placed in a boot with a heel lift to take the tension off the tendon while full treatment plan is being formulated.


  • Physical therapy. A physical therapist or athletic trainer may use ultrasound, electrical stimulation, cold therapy, and massage therapy to enhance Achilles tendon healing. The patient will be instructed on the proper way to stretch before exercise and use strength training exercises to resume normal daily activities and prevent future injuries.


Most people will find relief from the pain and swelling of Achilles tendonitis by using over-the-counter, nonsteroidal, anti-inflammatory medications such as:

  • Ibuprofen
  • Naproxen
  • Acetaminophen
  • Topical diclofenac

Injection Therapy

While corticosteroid steroids are to be avoided in and around the Achilles tendon, other percutaneous interventions can be tried for the more chronic forms of tendonitis. Your provider may recommend a needle debridement or a biologic injection such as platelet-rich plasma. This helps break up calcifications and scar tissue and encourages a good healing environment.

Surgical options

Surgical options are indicated in the case of acute total or partial rupture or severe tendonitis that hasn’t responded to the interventions above. There are three main types of Achilles tendon rupture surgeries.

  • Percutaneous Achilles repair. This minimally invasive surgery to treat Achilles tendon tears entails several small incisions along the back of the calf. The surgeon will insert a tiny tool through the incisions to remove damaged tendon tissue. The surgeon will then repair the tear to the tendon and attach the tendon to the heel bone with sutures and small screws. Making small incisions rather than one large incision promotes faster recovery with less scarring or complications.
  • Open Achilles repair. In open Achilles repair, an incision is made in the back of the calf, allowing the surgeon to remove damaged tissues resulting from a partially or wholly ruptured tendon. From there, they can repair the Achilles tendon tear and secure the ends of the severed tendon together. In addition, the surgeon can attach the tendon to the heel bone with sutures and surgical screws. The surgeon will close the incision with sutures. The calf will be swollen and tender from the surgery for a few days.
  • Tendon transfer. A tendon transfer takes the tendon used to flex the big toe, disconnects it, and reattaches it to the back of the calf. This tendon is sutured to the Achilles tendon for reinforcement. Eventually, the patient will gain muscle control in the big toe when the surrounding muscles assume control.
Get Care

Trust NewYork-Presbyterian for Achilles Tendon Pain Treatment

Know the symptoms of Achilles tendonitis. If you think you injured your Achilles tendon, make an appointment with your doctor or orthopedic specialist. The orthopedic experts at NewYork-Presbyterian and Columbia Orthopedics understand your concerns and combine their expertise to come up with a plan of treatment that fits your needs. Call today for an appointment.