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• Achilles tendonitis is irritation or degeneration of the tendon that runs from your calf to your heel.
• It typically shows up as pain and stiffness in the back of the heel, worst with the first steps of the day and after exercise.
• The most effective treatment is a guided, progressive loading program — the cornerstone of physical therapy for this condition.
• Continuing to run through Achilles pain risks a partial or complete rupture — get it evaluated rather than ignoring it.
• No referral is needed in most cases. We see new patients within a few days at Cedar Mill, Tigard, and Milwaukie.

What is Achilles tendonitis?

Achilles tendonitis is irritation of the Achilles tendon — the thick cord at the back of your ankle that connects your calf muscles to your heel bone. In acute cases the tendon is inflamed; in chronic cases (more accurately called tendinopathy or tendinosis) the tendon has started to break down at the fiber level and is no longer healing well on its own.

It is one of the most common overuse injuries we see in runners — especially those increasing mileage too fast or pushing pace on hills. It also shows up in weekend athletes returning to sport after a layoff, and in adults whose tendon quality has changed with age. Tight calves, sudden changes in footwear, and harder running surfaces all contribute.

At Creekside Physical Therapy, we use a graduated, progressive-loading protocol — the approach with the strongest evidence for this condition — paired with hands-on manual therapy and movement retraining. The vast majority of cases resolve without injections or surgery. You work one-on-one with the same therapist throughout.

The Achilles tendon is the largest and strongest tendon in the human body. It connects the gastrocnemius and soleus muscles of the calf to the back of the heel bone (calcaneus). When you push off in walking, running, or jumping, the Achilles transmits force from your calf into your foot. It tolerates enormous loads — but it has a relatively poor blood supply in its middle portion, which is why it heals slowly and is prone to overuse injury.

What it feels like

Achilles tendonitis has a recognizable pain pattern centered at the back of the heel:

• Pain and stiffness in the back of the heel, worst with the first steps of the day
• Aching in the tendon during or after running or other activity
• A thickened, sore spot you can feel along the tendon, usually a few centimeters above the heel
• Pain when squeezing the sides of the tendon
• Stiffness that loosens after a few minutes of walking, then returns the next morning
• Visible swelling or a soft lump along the tendon in more chronic cases
• A creaking sensation when moving the ankle in advanced cases

Why it develops

Achilles tendonitis is almost always an overuse problem, driven by some combination of these factors:

• A sudden increase in running mileage, pace, or hill work
• Tight calf muscles that overload the tendon with every step
• Switching to lower-drop or minimalist shoes too quickly
• Worn-out athletic shoes that have lost support
• Sport on hard surfaces (track, road, gym floor)
• Returning to sport after a long layoff without building back up
• Calf and lower-leg weakness that leaves the tendon doing too much of the work

How we evaluate Achilles tendonitis

Your first visit is a one-on-one physical therapy evaluation. Your therapist examines the back of the heel and ankle, locates the exact tender area along the tendon, tests calf strength and endurance, and assesses your ankle and calf flexibility and the way you walk and load. We do not use imaging — the evaluation is clinical. If your history suggests a partial tear or another problem that needs an X-ray or MRI, we coordinate that with your physician. Most patients leave the same day with a clear diagnosis and a written loading program.

How physical therapy treats it

Conservative physical therapy works for the vast majority of Achilles tendonitis cases. The cornerstone is a guided, progressive loading program — the intervention with the strongest evidence for this condition:

• A progressive calf-loading program (including eccentric heel-drops), individualized and advanced as you tolerate — typically the single most effective intervention
• Manual therapy to the calf, ankle, and foot to restore mobility and calm symptoms
• A calf stretching program targeting both the gastrocnemius and soleus
• Temporary heel lifts and activity modification to reduce tendon load while you build capacity
• Footwear guidance and a graded return-to-running plan
• Blood flow restriction (BFR) training to load the calf early when heavier work is not yet tolerated
• Movement and gait retraining to address what overloaded the tendon in the first place
• A structured home exercise program so the tendon keeps adapting between visits

When to seek care

• Achilles pain that has not improved after a week of relative rest
• A sudden pop or sharp pain in the back of the heel during activity — this could be a rupture and needs urgent medical evaluation before therapy
• Visible swelling, a lump, or thickening of the tendon
• Pain severe enough to change how you walk
• Symptoms that keep returning as soon as you go back to running

Achilles tendonitis is treated by Creekside’s physical therapists at all three clinics. Chad Smurthwaite, DPT, OCS, a board-certified Orthopedic Clinical Specialist and former collegiate distance runner, treats a high volume of Achilles injuries in runners and athletes. If a tendon problem is severe enough to need a procedure, we coordinate with your surgeon and lead your rehabilitation afterward.

Frequently asked questions

• Plantar Fasciitis & Heel Pain
  Often coexists — the same calf tightness drives both
• Foot & Ankle Tendinitis
  Other lower-leg tendons follow similar overload patterns
• Running Injuries
  Achilles pain is one of the most common running injuries
• Ankle Sprains & Instability
  Ankle mechanics can contribute to Achilles overload