Achilles Tendonitis: Early Signs, Causes & Treatment You Should Know

The Achilles tendon is the strongest tendon in your body, but it's also one of the most commonly injured. If you've been feeling a nagging stiffness in the back of your heel, especially first thing in the morning or after being on your feet all day, there's a good chance you're dealing with Achilles tendonitis.

This is one of the most common conditions we treat in the office, and it affects all kinds of people. Walkers, weekend hikers, people who spend long hours standing at work, dancers, gym-goers, and yes, runners too. The tricky thing about Achilles tendonitis is that it tends to start small. A little tightness here, some soreness there. Most people brush it off and keep going about their day. Then weeks later, they're limping into our office wondering how things got so bad.

Catching it early makes all the difference. Here's what you need to know:

What Is Achilles Tendonitis?

The Achilles tendon connects your calf muscles to your heel bone. Every time you walk, climb stairs, stand on your toes, or push off the ground, this tendon is doing the heavy lifting. When it gets overworked or stressed beyond what it can handle, the tissue becomes inflamed and irritated. That's Achilles tendonitis.

There are two main types: Insertional Achilles tendonitis affects the lower portion of the tendon where it attaches to the heel bone. Non-insertional Achilles tendonitis affects the middle of the tendon and is more common in younger, active people.

Both types are treatable, but they respond to slightly different approaches, which is why getting an accurate diagnosis matters.

Early Signs of Achilles Tendonitis

The earlier you catch this, the easier it is to treat. Here are the warning signs to watch for.

• Morning stiffness. One of the first things people notice is stiffness or pain in the back of the heel when they get out of bed. The tendon tightens up overnight, and those first few steps can feel rough.

• Pain after activity. You might feel fine while you're moving around, but the soreness shows up later that day or the next morning. This is a classic early sign.

• Tenderness when you press on the tendon. If you can feel a sore spot along the back of your heel or a few inches above it, that's worth paying attention to.

• Mild swelling. Some people notice a slight thickening of the tendon or a small bump. The area might feel warm to the touch.

• Tightness in the calf. Achilles tendonitis often goes hand in hand with tight calf muscles, since the two are directly connected.

• Discomfort going up stairs or standing on your toes. Any movement that requires the tendon to stretch and contract under load can become uncomfortable.

• If any of these symptoms have been hanging around for more than a week or two, don't wait it out. Achilles tendonitis tends to get worse, not better, when it's ignored.

What Causes Achilles Tendonitis?

This injury usually doesn't come from one specific event. It builds up over time from a combination of factors.

• Sudden increases in activity. Picking up a new workout routine, suddenly walking a lot more than usual, or jumping into an intense fitness class without easing in are all common triggers. The tendon needs time to adapt to new demands.

• Tight calf muscles. When your calves are tight, they pull on the Achilles tendon constantly. Over time, that tension takes a toll.

• Poor footwear. Unsupportive shoes, worn-out sneakers, and shoes without enough heel cushioning can all contribute. Constantly wearing flat shoes like flip-flops or going barefoot on hard floors can also strain the tendon.

• High heels. Wearing heels regularly shortens the calf muscles over time. When you switch to flat shoes, the sudden stretch on the tendon can lead to inflammation.

• Long hours on your feet. People who stand all day for work, especially on hard surfaces, often develop Achilles issues without ever stepping foot in a gym.

• Stairs and hills. Manhattan has no shortage of either. Climbing lots of stairs or walking up steep streets forces the Achilles to work harder than usual.

• Foot structure. Flat feet, high arches, or other structural issues can change the way force travels through your foot and put extra stress on the tendon.

• Age. The tendon naturally loses some flexibility and blood supply as we get older, which is why Achilles tendonitis is more common in people over 40.

• Weekend warrior syndrome. People who are mostly sedentary during the week and then go all-in on physical activity over the weekend are especially vulnerable.

• Certain medical conditions. Diabetes, high blood pressure, and certain antibiotics can also increase your risk.

How Is Achilles Tendonitis Diagnosed?

In most cases, we can diagnose Achilles tendonitis with a physical exam. We'll ask about your symptoms, look at how you walk, check the tendon for tenderness or swelling, and test your range of motion.

If we suspect a partial tear or want to rule out other issues, we may use ultrasound or MRI imaging. This is especially important if the pain has been going on for a while or isn't responding to treatment.

Treatment Options for Achilles Tendonitis

The good news is that most cases of Achilles tendonitis respond well to conservative treatment, especially when you catch it early. Here's what that usually looks like.

• Rest and activity modification. This doesn't always mean stopping everything, but it does mean backing off whatever activity is irritating the tendon. Switching to lower-impact movement for a few weeks can give the tendon time to calm down.

• Ice. Icing the area for 15 to 20 minutes after activity helps reduce inflammation and pain.

• Stretching and strengthening. Specific calf stretches and eccentric heel drop exercises are some of the most effective treatments for Achilles tendonitis. We often guide patients through a structured program, since doing these exercises incorrectly can actually make things worse.

• Heel lifts or orthotics. A small heel lift in your shoe takes some of the strain off the tendon. Custom orthotics can address underlying mechanical issues that are contributing to the problem.

• Physical therapy. A good physical therapist can work on flexibility, strength, and movement patterns to address the root causes of the injury.

• Anti-inflammatory medication. Over-the-counter options like ibuprofen can help with pain and swelling in the short term, but they're not a long-term solution.

• Shockwave therapy. For chronic cases that haven't responded to other treatments, extracorporeal shockwave therapy can stimulate healing in the tendon.

• Immobilization. In more severe cases, a walking boot might be necessary for a few weeks to give the tendon a chance to heal.

• Surgery. Surgery is rarely needed for Achilles tendonitis and is usually only considered after months of conservative treatment have failed. When it is necessary, the procedure removes damaged tissue and repairs the tendon.

How Long Does Achilles Tendonitis Take to Heal?

This is one of the most common questions we get, and the honest answer is that it varies. Mild cases caught early can resolve in a few weeks with proper care. More stubborn cases can take two to three months or longer.

The biggest factor is whether you actually follow the treatment plan. People who keep pushing through their normal activities, skip their stretching routine, or go back to full activity too soon almost always end up dealing with the injury for much longer than they need to.

Can I Stay Active With Achilles Tendonitis?

Probably not in the same way you're used to, at least for a while. Putting continued strain on an inflamed Achilles tendon is one of the fastest ways to turn a manageable problem into a serious one. A chronically irritated tendon can develop tiny tears, and in worst-case scenarios, it can rupture completely. An Achilles rupture often requires surgery and months of rehab.

That said, you don't necessarily have to stop everything. Low-impact activities like swimming or cycling are usually fine and can help you stay active without aggravating the tendon. The right approach depends on the severity of your case, which is why it's worth getting evaluated.

How Do I Prevent Achilles Tendonitis From Coming Back?

Once you've had Achilles tendonitis, you're more likely to deal with it again unless you address the underlying causes. A few habits make a big difference.

Stretch your calves regularly, even on days you're not exercising. Strengthen the muscles around your ankle and lower leg. Don't ramp up activity levels too quickly. Replace your shoes on a regular basis. Pay attention to early warning signs and back off before things get worse.

If you have flat feet, high arches, or any other structural issue, custom orthotics can help redistribute the load on your tendon and prevent flare-ups.

When Should You See a Podiatrist?

If your symptoms have been going on for more than a week or two, if the pain is getting worse, if you notice swelling or a lump along the tendon, or if the discomfort is changing the way you walk, it's time to come in.

Achilles tendonitis is one of those conditions where early intervention saves you a lot of time and frustration. The longer you wait, the longer recovery tends to take.

Whether you're an active gym-goer, someone who walks miles around the city every day, or you spend long hours on your feet at work, your Achilles tendon needs to be taken care of. Don't wait until you can barely walk to get help.

If you're noticing any of the early signs we covered, schedule an appointment. We'll figure out exactly what's going on and put together a treatment plan that gets you back to your normal life without the pain.

Top 5 Running Injuries That Affect the Feet and Ankles (And What Manhattan Runners Need to Know)

If you've ever finished a run along the Hudson River Greenway or pushed through a loop in Central Park only to feel a sharp pain in your heel the next morning, you're not alone. Running is one of the most popular forms of exercise in Manhattan, but it's also one of the leading causes of foot and ankle injuries we see in the office.

The good news? Most running injuries are preventable, and almost all of them are treatable when caught early. The bad news? Too many runners ignore the warning signs until a small problem turns into something that sidelines them for months.

Here's a breakdown of the five most common running injuries that affect the feet and ankles, plus answers to the questions runners ask us (and Google) the most.

1. Plantar Fasciitis

This is hands down the most common running injury we treat. Plantar fasciitis is inflammation of the thick band of tissue that runs along the bottom of your foot, connecting your heel to your toes.

You'll usually feel it as a stabbing pain in the heel, especially with your first few steps in the morning or after sitting for a while. It often eases up once you start moving, which is why runners tend to brush it off. The problem is that running on it actually makes the underlying inflammation worse, even if it feels better mid-run.

Common causes include tight calves, worn-out shoes, sudden increases in mileage, and running on hard surfaces like the concrete sidewalks all over Manhattan.

2. Achilles Tendinitis

The Achilles tendon connects your calf muscles to your heel bone, and it takes a beating every time your foot pushes off the ground. When you ramp up your training too quickly or run a lot of hills (looking at you, runners who train on the Harlem Hills loop), the tendon can become irritated and inflamed.

Symptoms include stiffness in the back of the heel, especially in the morning, along with pain that worsens during or after a run. Some runners notice swelling or a lump along the tendon itself.

Ignoring Achilles tendinitis is one of the worst things you can do. A chronically inflamed tendon can eventually rupture, and that's a much bigger problem than a few weeks of rest and rehab.

3. Stress Fractures

A stress fracture is a tiny crack in the bone caused by repetitive impact. In runners, they show up most often in the metatarsals (the long bones in the middle of your foot) or in the heel bone.

Unlike a sudden break from a fall, stress fractures sneak up on you. The pain usually starts as a vague ache during runs, then gets sharper and more localized. You might notice swelling or tenderness when you press on a specific spot.

If you suspect a stress fracture, stop running. Continuing to train on a stress fracture can turn a small crack into a complete break, which could mean surgery and a much longer recovery. We typically diagnose these with imaging, since they don't always show up on a basic X-ray right away.

4. Ankle Sprains

Manhattan is a minefield of cracked sidewalks, uneven curbs, and potholes you can't see until you've already stepped in one. It only takes one bad step to roll your ankle, and depending on the severity, you might be dealing with anything from mild ligament stretching to a full tear.

Most sprains involve the outside of the ankle, where the ligaments are more vulnerable. You'll feel immediate pain, often followed by swelling and bruising. Walking might be uncomfortable or impossible.

A lot of runners try to walk off an ankle sprain and get back to training too soon. This is a mistake. Ligaments need time to heal properly, and rushing the process leads to chronic ankle instability, which means you're more likely to sprain it again and again.

5. Shin Splints

Technically called medial tibial stress syndrome, shin splints cause aching pain along the inside of the shin bone. They're most common in newer runners or those who've recently increased their mileage, switched to harder surfaces, or started wearing different shoes.

The pain usually starts as a dull throb that goes away once you warm up, but over time it can become more persistent and intense. If left untreated, shin splints can progress into a stress fracture in the tibia.

Now let's get into the questions runners ask all the time.

How Do I Know If My Running Injury Is Serious?

A few red flags tell us an injury needs immediate attention. If you can't put weight on the foot, if there's significant swelling or bruising, if the pain is sharp and localized to one spot, or if symptoms don't improve after a few days of rest, it's time to come in.

General soreness after a hard run is normal. Pain that changes the way you walk or run is not.

Can I Run Through the Pain?

Almost always, the answer is no. Running through pain is how minor issues become major ones. Pain is your body's way of telling you something is wrong, and ignoring it doesn't make it go away. It just gives the problem more time to get worse.

There's a difference between discomfort (tired legs, mild soreness) and pain (sharp, persistent, localized). If you're not sure which one you're dealing with, that's a good reason to get it checked out.

How Long Does It Take to Recover From a Running Injury?

It depends entirely on the injury and how soon you address it. Mild plantar fasciitis or shin splints might resolve in a few weeks with proper care. A stress fracture typically takes six to eight weeks of no running. A bad ankle sprain can take anywhere from two weeks to several months depending on severity.

The biggest factor in recovery time is how quickly you start treatment. Runners who come in at the first sign of trouble almost always heal faster than those who wait.

What Shoes Should I Be Running In?

There's no single best shoe for every runner. The right shoe depends on your foot structure, your gait, your weekly mileage, and the surfaces you run on. What works for your training partner might be completely wrong for you.

That said, the most important rule is to replace your shoes regularly. Most running shoes lose their cushioning between 300 and 500 miles. If you've been running in the same pair for a year and you're logging consistent mileage, they're probably part of the problem.

If you're dealing with recurring injuries, a gait analysis can identify issues with your stride or foot mechanics that the right shoe (or custom orthotic) can help correct.

How Can I Prevent Running Injuries?

A few habits go a long way. Increase your weekly mileage gradually, no more than about 10 percent per week. Don't skip strength training, especially for your hips, glutes, and core, since weakness in these areas often shows up as foot or ankle pain. Stretch your calves and hips regularly. Replace your shoes on schedule. And listen to your body when it's telling you to back off.

Cross-training with low-impact activities like swimming or cycling also gives your feet and ankles a break from the constant pounding.

When Should I See a Podiatrist?

If you've tried rest, ice, and over-the-counter anti-inflammatories for a week or two and the pain isn't getting better, come in. The same goes for any injury that's affecting how you walk or run, any pain that's getting worse instead of better, or any injury that keeps coming back even after you think it's healed.

Running is supposed to make you feel good. If it's hurting you, something needs to change, and we can help figure out what.

Whether you're training for the New York City Marathon or just trying to keep your weekly Central Park loop in your routine, your feet and ankles deserve attention. Don't wait for a small ache to become something that takes you out of the game for months.

If you're dealing with any of these injuries, or if you just want a checkup before your next training cycle, schedule an appointment. The sooner we catch something, the sooner you're back on the road.

Plantar Fasciitis vs. Heel Spurs: How to Tell the Difference

What if the heel spur you’re worried about isn’t the real problem, but the inflammation around it is?

Confusing plantar fasciitis and heel spurs is extremely common. In fact, many people with heel spurs have no pain at all, while others experience significant heel pain without any spur present.

Understanding the difference between plantar fasciitis and heel spurs can prevent unnecessary fear, delayed treatment, and even the wrong kind of care.

In this article, we’ll break down exactly what each condition is, how they’re different, and how to know what’s actually causing your heel pain.

What Is Plantar Fasciitis?

Plantar fasciitis is inflammation of the plantar fascia, a thick band of connective tissue that runs along the bottom of your foot from the heel to the toes.

The plantar fascia supports your arch and absorbs shock every time you walk.

When this tissue becomes irritated or overloaded, it can develop small micro-tears. That inflammation is what causes pain.

Common Symptoms of Plantar Fasciitis:

• Sharp, stabbing pain in the bottom of the heel

• Pain that is worst with the first steps in the morning

• Discomfort after long periods of sitting

• Pain that improves slightly with movement but returns after activity

  
  

Plantar fasciitis is a soft tissue condition, not a bone problem.

It is one of the most common causes of heel pain, especially in adults who walk frequently, stand for long hours, or wear unsupportive footwear.

What Is a Heel Spur?

A heel spur is a calcium deposit that forms along the underside of the heel bone (calcaneus).

Over time, repetitive strain of the plantar fascia can cause the body to lay down extra bone where the plantar fascia attaches to the heel.

Heel spurs:

• Develop gradually

• Are visible on X-rays

• May be present with or without any pain

  
  

Here’s what often surprises patients:

Many people have heel spurs and never experience symptoms.

In fact, the spur itself usually does not cause pain. The discomfort typically comes from inflammation of the surrounding soft tissue, often plantar fasciitis.

A heel spur is structural. Pain is usually inflammatory.

How to Tell the Difference Between Plantar Fasciitis and Heel Spurs

Because the two conditions often occur together, the symptoms can feel similar. But there are key differences:

Feature	Plantar Fasciitis	Heel Spur
What Is it?	Inflammation of the plantar fascia (soft tissue)	Calcium deposit on the heel bone
Type of Condition	Soft tissue injury	Structural bone growth
Most Common Symptom	Sharp pain with first steps in the morning	Often no pain at all
Location of Pain	Bottom of heel, arch area	May feel similar if inflamed tissue is involved
Visible on X-Ray?	Not usually	Yes
Primary Cause of Pain	Inflammation	Usually inflammation around the spur
Treatment Focus	Reduce inflammation & improve flexibility	Often same conservative treatment

If you’ve been told you have a heel spur, it doesn’t automatically mean that bone growth is the source of your pain.

In many cases, plantar fasciitis is the true cause, even when a spur appears on imaging.

That’s why a proper evaluation matters.

Can You Have Both Plantar Fasciitis and a Heel Spur?

Yes. Chronic strain on the plantar fascia can sometimes lead to heel spur formation over time.

However, even when both are present, inflammation of the plantar fascia is usually the primary source of discomfort.

This is an important distinction, because it influences how treatment should be approached.

Does the Diagnosis Change Treatment?

In most cases, treatment for plantar fasciitis and heel spur-related heel pain is very similar.

The focus is on reducing inflammation, improving flexibility, and correcting biomechanical stress.

Conservative Treatment Options Include:

• Stretching the calf and plantar fascia

• Wearing supportive footwear (even indoors)

• Custom orthotics

• Activity modification

• Physical therapy

• Anti-inflammatory measures

  
  

Advanced therapies may be considered if symptoms persist.

Surgery to remove a heel spur is uncommon and typically only considered when conservative treatments have failed over time.

Understanding the difference between plantar fasciitis and heel spurs helps prevent unnecessary procedures and ensures that treatment targets the real source of pain.

When Should You See a Podiatrist?

You should consider an evaluation if:

• Heel pain lasts more than 2–3 weeks

• Pain interferes with walking or work

• Symptoms are worsening

• You experience swelling, redness, or numbness

• Heel pain keeps returning

  
  

For many busy professionals walking daily through Manhattan, Brooklyn, or Flushing, early diagnosis makes treatment simpler and recovery faster.

The sooner the true cause of heel pain is identified, the easier it is to address.

Don’t Let Confusion Delay the Right Treatment

If you’ve been told you have a heel spur, or you suspect plantar fasciitis, clarity is the first step toward relief.

Many patients are relieved to learn that the “bone growth” they feared isn’t actually the source of their pain.

Our podiatry team provides comprehensive heel pain evaluations at all three NYC locations in Manhattan, Brooklyn, and Flushing. We focus on accurate diagnosis and conservative treatment whenever possible, helping you return to comfortable walking without unnecessary surgery.

If your heel pain has persisted or continues to interfere with your daily routine, you can schedule an appointment at the location most convenient for you.

Book online or call our office to find a time that works for your schedule.