Achilles Tendonitis

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Pain or tightness at the back of the heel? Get expert evaluation and treatment for Achilles tendonitis—bracing, loading rehab, heel lifts, and surgical options when needed. Same-week care in San Mateo.

Achilles tendonitis (often called Achilles tendinopathy) is irritation or degeneration of the tendon that connects your calf muscles to your heel. It can occur in the mid-portion of the tendon (a few centimeters above the heel) or at the insertion where the tendon attaches to the heel bone.

Common symptoms

• Achy or sharp pain at the back of the heel or above it
• Morning stiffness that eases as you move
• Tenderness or a thickened “knot” along the tendon
• Pain with running, hills, or after longer walks/standing

Why it happens (risk factors)

• Sudden increases in training, hills, or speed work
• Tight calves, limited ankle motion
• Flat feet or very high arches changing load on the tendon
• Unsupportive footwear; prior ankle/foot injuries

We begin with a focused history and exam to pinpoint mid-portion vs. insertional pain and check calf/ankle flexibility.

• Ultrasound can assess tendon thickness and partial tears;
• X-rays evaluate heel spurs or calcification at the insertion;
• MRI is reserved for persistent or complex cases.

Most people improve without surgery when the plan targets load, flexibility, and mechanics.

Settle symptoms (early phase)

• Relative rest and temporary activity modification
• Heel lifts to reduce tendon strain (especially for insertional cases)
• Short course of anti-inflammatory measures as appropriate
• Ice/contrast and gentle calf mobility

Rehab & loading (core phase)

• A progressive loading program (eccentric or heavy–slow resistance) designed to the exact location of your pain
• Calf/hip strengthening and balance work
• Footwear guidance and, when indicated, custom orthotics to improve mechanics
• Night comfort options if morning stiffness is severe

Bracing & adjuncts (select cases)

• Short period in a walking boot for acute flares or partial-tear protectionbtiously; we’ll review risks/benefits together

If pain and function don’t improve after a structured rehab program, or if imaging shows significant degenerative changes or a partial tear that isn’t healing, surgery may help. Options include debridement of diseased tissue, possible bone spur removal for insertional cases, and tendon augmentation/transfer when needed. We’ll discuss timelines, risks, and return-to-activity goals.

1. Evaluation: Exam, footwear review, and imaging as needed.
2. Plan: A clear week-by-week loading and mobility program with shoe/insert guidance.
3. Follow-up: Progress checks at 4–8 weeks to advance loading and activity.

Most patients see meaningful improvement within 6–12 weeks with consistent care; chronic cases may take longer but still respond to the right plan.

• Sudden pop in the back of the ankle with immediate weakness or trouble pushing off (possible rupture)
• Rapidly worsening swelling, redness, or fever
• Inability to bear weight after an injury

• Board-certified care led by Hannah Lee, DPM
• Emphasis on evidence-based loading rehab and prevention first
• On-site imaging, bracing guidance, custom orthotics when helpful
• Surgical solutions tailored to your anatomy and activity goals when needed

Should I stop all activity?
Not necessarily. We’ll modify load, then rebuild strength with a structured plan so you can return safely.

Eccentric vs. heavy–slow resistance—what’s best?
Both can work. We’ll choose based on your exam and whether your pain is mid-portion or insertional.

Are injections recommended?
Some injections may relieve pain but can also carry risk to tendon tissue. We’ll review options carefully and prioritize proven rehab first.

Can shoes or orthotics help?
Yes—supportive footwear and custom orthotics can reduce excess strain and complement rehab.

Let’s design a plan that calms the pain and builds lasting strength.