Achilles tendon pain

Definition

What is Achilles tendon pain?
The Achilles tendon (Tendo calcaneus) is the common terminal tendon of the three-headed calf muscle (Musculus triceps surae), which consists of the two-headed gastrocnemius (Musculus gastrocnemius) and the soleus muscle (Musculus soleus), and connects it to the heel. It is the thickest and strongest tendon in the human body. The Achilles tendon plays a decisive role in movements such as walking, running and jumping, as it transmits force from the calf muscles to the foot.

We distinguish three clinical pictures for Achilles tendon pain or inflammation of the Achilles tendon:

Achillodynia (Achilles tendinopathy) / Acute Achilles tendinitis

• Lack of exercise, frequent sitting.
• One of the most common running injuries.
• Caused by too rapid an increase in the volume or intensity of training.
• Diffuse, dull or stabbing pain in the area of the Achilles tendon. Often the pain is at the Achilles tendon insertion.
• If the Achilles tendon is inflamed, the healing time depends on the severity of the inflammation and the physical condition of the affected person. With an ideal healing course, the Achilles tendon inflammation subsides within 4-6 weeks. Appropriate therapy for Achilles tendinitis is important so that chronic Achilles tendinitis does not develop.

Chronic Achilles tendinitis

• If the acute Achilles tendinitis lasts longer than six weeks or is not treated, it is considered chronic Achilles tendinitis.
• Chronic Achilles tendinitis can lead to a thickened Achilles tendon and cause persistent pain; nodules on the Achilles tendon can be felt. “Achilles tendon nodules” can be loosened by massage.
• Chronic Achilles tendinitis can also be treated with targeted Achilles tendinitis therapy and can lead to complete relief. The duration of chronic Achilles tendinitis varies depending on the severity of inflammation and treatment.

Achilles tendon rupture / partial tear

• A rupture of the Achilles tendon is only possible under great force, therefore the tendon is usually already damaged beforehand (e.g. by acute or chronic Achilles tendinitis or Achilles tendon irritation).
• Triggered by sudden contraction of the calf muscles.
• If the tendon is completely severed, standing or walking is no longer possible. Treatment of an Achilles tendon rupture often requires surgical fixation of the tendon to the calcaneus. Postoperative treatment for Achilles tendon rupture is lengthy. First, the Achilles tendon must be immobilized for 4 to 6 weeks. This is followed by reduced loading over three months.

Causes of Achilles tendon pain

The causes of Achilles tendon pain or Achilles tendinitis are closely related to modern lifestyle and changed environmental conditions. Our ancestors moved holistically and intensively to obtain food — whether by hunting, gathering berries or farming. These activities mostly took place barefoot on natural, uneven ground, which optimally challenged and strengthened the foot and leg muscles.

Over millennia, lifestyle has changed dramatically. Today, lack of physical activity and a predominantly sedentary lifestyle are widespread. When movement does occur, it usually takes place on hard, flat surfaces such as concrete or asphalt — often in stiff, supportive shoes. These changed conditions affect both the quantity and quality of movement and lead to bodily adaptations that can inflame or overload the Achilles tendon. The following describes the effects of these changes on the development of Achilles tendon pain.

Lack of exercise and sedentary lifestyle

Modern lifestyles characterized by lack of exercise and prolonged sitting place abnormal loads on the musculoskeletal system. Lack of exercise and a sedentary lifestyle lead to physical adaptations that can cause pain in the Achilles tendon. The following changes significantly contribute to the development of Achilles tendon pain and explain why the Achilles tendon becomes inflamed:

• Weakened musculature

  Lack of exercise and a predominantly sedentary lifestyle cause essential muscles to atrophy. Weakened foot muscles can no longer sufficiently stabilize the longitudinal arch, impairing the natural shock-absorbing function and increasing load on the Achilles tendon. Reduced calf muscle strength also weakens their stabilizing and relieving function, which can lead to mis- and overloading of the Achilles tendon. The combination of weak foot and calf muscles also impairs the natural rolling motion of the foot from heel over midfoot to forefoot. As a result, the Achilles tendon lacks the necessary lengthening and shortening, leading over time to injury and inflammation of the tendon.
  

• Foot deformities

  A weakened musculature can also promote foot deformities. As explained above, muscle weakness often leads to lowering of the longitudinal arch, resulting in a fallen or flat foot — with the impacts on the Achilles tendon already mentioned. In addition, weak foot muscles can cause pronation (rolling inward) or supination (rolling outward). This causes the Achilles tendon to be pulled inward or outward with each step, significantly increasing the risk of tendon inflammation.
  

• Fascial dysfunction

  Lack of exercise and prolonged sitting have a major impact on fascial health. Fascia wrap muscles and regulate force transmission. For fascia to work properly, they must retain elasticity. Inactivity and poor posture lead to fascial adhesions and tension. Prolonged sitting shortens the muscle-fascia chain from the lower leg to the thigh. This shortening pulls on the Achilles tendon, creating persistent increased tension and, over time, damage to the tendon. As a result, the tendon becomes inflamed and can lead to Achilles tendon pain.
  

• Joint stiffness

  If the foot is not regularly moved through its full range of motion, the foot joints lose mobility. This natural stiffening results in reduced rolling motion of the feet. The missing roll from heel to forefoot means that the Achilles tendon is not sufficiently lengthened and stretched, which makes the tendon brittle and prone to injury. On the other hand, repetitive movement over the same area increases force impact and leads to overload, which can result in Achilles tendon inflammation.

Hard, flat floors and stiff, supportive shoes

Changed environmental conditions strongly affect the load on the musculoskeletal system. Hard, flat floors and stiff, supportive shoes alter the biomechanics of each step and are therefore a key factor in the causes of Achilles tendon pain or Achilles tendinitis. The following changes significantly contribute to Achilles tendon pain and explain why the tendon becomes inflamed:

• Impact force

  When walking on hard, flat floors and in stiff, supportive shoes, higher forces act on the musculoskeletal system, especially during heel strike. Because industrial floors are rigid and conventional shoe soles are stiff, the forces cannot be absorbed, leading to increased load on the body. These increased forces first affect the feet and therefore the Achilles tendon. The elevated impact results in mis- and overloading of the Achilles tendon, which can lead to inflammation. As a consequence of inflammation, a thickened Achilles tendon may form.
  
  Furthermore, the increased and early force application shortens the possible reaction time of the muscles involved. If the muscles cannot contract in time, the relevant joint is insufficiently stabilized. The ankle joint plays an especially important role in the development of Achilles tendon pain. Because the Achilles tendon attaches to the calcaneus, instability around the ankle can cause overstretching or torsion of the Achilles tendon. Consequently, the tendon becomes inflamed and can cause Achilles tendon pain.

• Unnatural sequence of movement

  Hard, flat floors and stiff, supportive shoes significantly hinder physiological movement sequences. On the one hand, the lack of muscle activation during heel strike (see “Impact force”) causes the foot to collapse uncontrolled downward. The so-called “collapsing foot” (foot drop) occurs. This causes the Achilles tendon to be “struck” with each step rather than guided in a controlled manner. The uncontrolled dropping of the foot causes the Achilles tendon to contract rapidly with each step, which can lead to inflammation. On the other hand, a natural forefoot roll is reduced. Due to the missing roll, the Achilles tendon is more heavily loaded in a reduced area, which can inflame and injure the tendon. The natural contraction of the Achilles tendon during forefoot roll, which keeps the tendon supple and elastic and thereby protects it from mis- and overloading, is also lacking.

• Weakened musculature

  The passivity of the feet on hard, flat floors and in stiff, supportive shoes also leads to atrophy of essential muscles that support the longitudinal arch and protect the foot from deformities. Due to weakened muscles, the Achilles tendon is mis- and overloaded, which can cause inflammation or pain in the Achilles tendon. Walking on compliant natural surfaces (e.g. sand or moss) challenges and strengthens the responsible muscles and therefore benefits the feet.

Symptoms of Achilles tendon pain

It is important to note that the following lists are the most common symptoms of Achilles tendinitis or Achilles tendon pain. The list of symptoms is not exhaustive. Atypical symptoms are also possible and are not listed here. Symptoms depend on factors such as pain sensitivity, cause of injury, severity of injury and physical condition. To obtain a definitive diagnosis for Achilles tendon pain, a physician should be consulted. MRI can be used to diagnose Achilles tendinitis.

• Pain along the Achilles tendon: Usually occurs during walking, running or after prolonged load and may persist at rest.
• Morning stiffness: Especially after getting up, the Achilles tendon feels stiff and immobile. Patients often report Achilles tendon pain in the morning after rising.
• Tenderness to pressure: The Achilles tendon hurts when touched or with light pressure, especially in the mid-portion or at the insertion.
• Thickening / swelling of the Achilles tendon: A swollen or thickened Achilles tendon indicates an inflamed tendon or tendon irritation. An inflamed tendon or tendon irritation causes thickening due to microscopic damage, fluid accumulation and disturbed healing.
• Redness and warmth: The affected area may be red and feel warmer than the surrounding tissue. Redness and warmth are symptoms of Achilles tendinitis.
• Heel pain: With Achilles tendon irritation or tendinitis, pain can occur at the heel or Achilles tendon. Especially with insertional Achilles tendinitis, precise localization can be difficult because the tendon’s attachment to bone experiences particularly high stress. The insertion often leads to pain due to the transition from bone to tendon experiencing high tension and force.
• Restricted mobility: The ankle joint cannot be fully extended or flexed, especially in stretching exercises.
• Pain after rest / start-up pain: Symptoms worsen after prolonged inactivity but improve with movement. The Achilles tendon hurts in the morning or after prolonged sitting.
• Load-dependent pain: Pain increases during activities like running or jumping.
• Sensation of weakness in the calf: Due to reduced load capacity of the Achilles tendon, the calf muscles may lose strength.

Conventional therapies - What helps for Achilles tendon pain

There are several approaches to treat Achilles tendinitis or Achilles tendon pain. Below are some therapies for Achilles tendon pain and Achilles tendinitis. This list is not exhaustive. If the Achilles tendon hurts or is inflamed, various measures may be used for treatment. Consulting a physician is recommended to determine the appropriate treatment for Achilles tendinitis or Achilles tendon pain.

• Rest and load reduction: Temporary protection of the Achilles tendon helps acute inflammation subside. Sudden, high loads should be avoided and replaced with controlled movements.
  
• Cooling: Ice packs or cooling gels relieve acute Achilles tendon pain and reduce inflammation. They can also reduce swelling of the Achilles tendon.
• Medication: Anti-inflammatory and pain-relieving drugs such as ibuprofen can help.
  
• Stretching and strengthening exercises: Specific exercises improve tendon structure and promote healing.
  
• Physiotherapy: Targeted manual therapy and mobilization techniques improve circulation, release tension and strengthen surrounding muscles.
  
• Insoles and appropriate footwear: Orthotic insoles or cushioned shoes with heel lift relieve the Achilles tendon and support natural foot mechanics.
• Shockwave therapy: High-energy sound waves stimulate circulation and promote tendon regeneration, especially in chronic conditions.
  
• Compresses: Compresses for Achilles tendinitis (e.g. quark compress) can relieve the inflamed Achilles tendon, reduce inflammation and minimize swelling.
  
• Home remedies for Achilles tendinitis: Apple cider vinegar, ginger and turmeric have anti-inflammatory effects. Foot baths with Epsom salts relieve inflammation and relax muscles.
  
• Anti-inflammatory ointments: An ointment can help reduce inflammation of the Achilles tendon.
  
• Taping and bandages: Taping can be an option to relieve a painful or swollen Achilles tendon. Special kinesio tapes or bandages stabilize the Achilles tendon and reduce uncontrolled movements, which supports healing.
  
• Massages and fascial therapy: Targeted massages or foam rolling can reduce tension in the calf muscles and release adhesions.
• Alternative therapies: Acupuncture, laser therapy or ultrasound treatments can additionally help relieve pain and accelerate regeneration.
  
• Adjustment of running and walking habits: An analysis of running technique or gait can help identify and correct misloads to prevent future complaints.
  
• Surgery: In severe cases, if conservative measures are insufficient, surgery may be necessary.

Often these measures do not lead to long-term pain reduction because the causes of Achilles tendon pain are not addressed. The goal of any treatment for Achilles tendinitis or Achilles tendon pain should therefore be elimination of the causes. As described above, lack of exercise, the sedentary lifestyle, hard flat floors and stiff, supportive shoes should be addressed. The kybun mode of action proves to be a suitable treatment for Achilles tendinitis or Achilles tendon pain, as it can remove the causes mentioned.

kybun mode of action - What helps for Achilles tendon pain

kybun products aim to eliminate the harmful effects of hard, flat floors and stiff, supportive shoes and to actively address lack of exercise and a sedentary lifestyle. Due to the elastic-springy properties of kybun products, the feet are both relieved and activated. The relief initially reduces Achilles tendon pain. Activation addresses the causes of Achilles tendon inflammation and pain so that complaints are reduced in the long term. Thus kybun shoes are well suited for treating Achilles tendinitis and Achilles tendon pain because they help through the following mechanisms:

• Reduction of force from hard, flat floors through a damping effect

  During heel strike in kybun shoes, the elastic-springy material compresses. Due to this slow sinking of the heel into the kybun sole, the load on the Achilles tendon increases more slowly. The muscle can use this time gain for adequate stabilization of the ankle joints and the Achilles tendon. More on this in the following section. In addition, the cushioning effect of the elastic-springy sole reduces the force acting on the Achilles tendon, protecting it from mis- and overloading. By reducing the impact, the risk of Achilles tendon inflammation is minimized.

• Activation of foot muscles through elastic-springy property

  As already mentioned, muscles can contract in time due to the slow sinking of the heel into the elastic-springy kybun material and thereby stabilize the ankle joints and Achilles tendon sufficiently. A contracted musculature reduces load intensity and thus minimizes the risk of Achilles tendon inflammation or general Achilles tendon pain.
  
  Furthermore, the feet on elastic-spring kybun shoes are constantly slightly in motion and must maintain balance. This activity trains the foot and leg muscles. Well-developed and trained foot and leg muscles stabilize the ankle joints and the Achilles tendon. In addition, activation of the foot and leg muscles also addresses foot deformities that can favor a painful or inflamed Achilles tendon. Especially lowering of the longitudinal arch and pronation lead to additional load on the Achilles tendon.

Balance and EMG

Balance ability was measured with a force plate by tracking center-of-mass movement front-to-back (ant-post) and side-to-side (med-lat) while standing. Simultaneously, electromyography (EMG) recorded muscular activity.

• Natural foot roll thanks to muscle activation and roll-off function

  Thanks to the reduced and delayed impact, the foot and leg muscles can stabilize the foot in time. On the one hand, this prevents the uncontrolled collapse of the foot after heel strike, which heavily stresses the Achilles tendon and increases the risk of tendon inflammation. After heel strike, the foot can be placed on the ground in a controlled manner through activation of the appropriate muscles, so that the Achilles tendon contracts gently.
  Furthermore, the elastic-springy sole with roll-off function and the rebound effect allow a natural roll-over the forefoot. The kybun sole’s rebound effect briefly stores force at heel strike and then uses it for forward propulsion. Thanks to the roll-off function, the Achilles tendon’s range of motion increases and it is slightly stretched and contracted with each step, keeping it flexible and resistant to load. A mobile Achilles tendon reduces tension and thus protects against inflammation and, consequently, Achilles tendon pain.

• Protection from fascial dysfunction thanks to physiological movement sequence

  Thanks to the slow sinking at heel strike and the controlled roll-off, a physiological gait is enabled, which also protects the fascia from structural changes. A functioning fascial network reduces tension on the Achilles tendon and protects it from mis- and overloading.
  

• Improved circulation through increased movement activity

  The Achilles tendon is far from the heart. For this reason and because of its general structure, the tendon is poorly supplied with blood, even worse than most other tendons in the body. This is one reason why healing in Achilles tendon pain and Achilles tendinitis often takes longer than desired. The elastic-springy kybun shoes promote movement and thereby activate the muscles around the feet and legs. This improves blood flow to the Achilles tendon, which facilitates the removal of inflammation-promoting substances and optimizes oxygen supply to the tissue. Better tissue perfusion with blood and oxygen promotes healing and regeneration of a damaged and inflamed Achilles tendon.
  

• Promotion of activity and reduction of sedentary behavior

  The elastic-springy kybun products increase the joy of movement because their unique material relieves the Achilles tendon while walking and standing. The resulting muscle activation strengthens muscles and improves circulation — advantages already explained in previous sections. In addition, using kybun products can reduce the duration of sitting activities and thus prevent harmful shortenings and blockages of the myofascial structures. Increased walking and standing gently stretch and contract the Achilles tendons with each step, keeping them flexible and load-resistant. At the same time, often shortened calf and thigh muscles are stretched and elongated, which positively influences the pull on the Achilles tendons.

Usage tips for Achilles tendon pain

Before wearing kybun shoes for the first time, you should consider some usage tips. Correct use of the kybun shoes can help alleviate complaints. In addition to kybun shoes, treat an inflamed, irritated or painful Achilles tendon with targeted Achilles tendon pain and Achilles tendinitis therapy, which is described in the next section.

• Wear kybun shoes at the beginning only for as long as your body tolerates. Introduce wearing breaks if the Achilles tendon hurts, the pain increases or musculoskeletal fatigue occurs. If the Achilles tendon hurts or is inflamed, treatment is time-consuming and requires patience. Due to the activating properties of kybun products, muscles are trained, which can lead to so-called initial reactions, especially at the beginning.
  
• Press your heel slowly and controlled into the elastic-springy material so that the Achilles tendon is relieved. Try to find a load point at which striking the ground reduces Achilles tendon pain or the pain does not occur. At the start, be careful not to roll too far over the heels.
  
• Take small and controlled steps at first, avoiding a steep heel strike to minimize tension on the Achilles tendon. Place the foot as flat as possible. Initially reduce forefoot roll so the Achilles tendon is not moved too strongly. If the tendon is inflamed, a low-movement step pattern is crucial. Gradually increase the foot range of motion over time if possible.
  
• Try the following Achilles tendon pain and Achilles tendinitis exercises to enhance the effectiveness of kybun shoes and increase the likelihood of recovery. These are intended as complementary Achilles tendon pain and Achilles tendinitis therapy and should be part of the overall treatment.

Helpful exercises for Achilles tendon pain

To enhance the effectiveness of kybun shoes and increase the likelihood of recovery from Achilles tendon pain, we recommend the following exercises for Achilles tendon pain or an inflamed Achilles tendon. The selection of exercises is not exhaustive and can be supplemented by further exercises for Achilles tendon pain and Achilles tendinitis. As a rule, exercises must not increase Achilles tendon pain. If any exercise increases pain, it must be stopped. Pleasant and releasing “discomfort” outside the pain point (e.g. in the calf) is desirable.
The exercises for Achilles tendon pain and Achilles tendinitis are divided into the following areas: “Proper walking in kybun shoes”, “Muscle length training”, “Foam rolling (fascia rolling)” and “Strengthening”. Ideally, the different areas are used complementarily in therapy for Achilles tendon pain and Achilles tendinitis.
Proper walking in kybun shoes
The quality of each step is crucial when treating Achilles tendinitis and Achilles tendon pain to reduce pain and eliminate mis- and overloading. kybun shoes therefore offer an ideal therapy for Achilles tendon pain and Achilles tendinitis.

Controlled heel strike

• Do not place the heel too steeply to reduce stretch on the Achilles tendon initially.
• Press the heel as flat and controlled as possible into the elastic-springy material to determine the load intensity and point at which stepping is possible or Achilles tendon pain is reduced.
• Maintain controlled foot posture so the foot does not tip inward or outward.
• Set down mid- and forefoot slowly and controlled so the Achilles tendon is not excessively irritated.
• Active forefoot roll-off should not be performed yet. The focus is on physiological heel strike.

Controlled roll-off

• Light forefoot roll-off without actively pushing off strongly with the big toes. Active push-off further stresses the Achilles tendon and should be avoided with a painful, irritated or inflamed tendon.
• Explore the possible range of foot movement without provoking pain or increasing Achilles tendon pain. Increase the range of motion if possible.

Muscle length training
Muscle length training is crucial in treating Achilles tendinitis and Achilles tendon pain because these often result from shortenings and tensions of the posterior chain (e.g. plantar fascia, calf and posterior thigh muscles). Targeted stretching exercises can actively address shortenings and tensions and thus form an ideal therapy for Achilles tendon pain and Achilles tendinitis. When performing the exercises, ensure the Achilles tendons are not exposed to excessive tension. Achilles tendon pain should not increase after muscle length training. If it does, the training was too intense.

Calf muscles

• Start position in a lunge.
• The rear heel has contact with the ground and should not be lifted.
• Slowly bend the front knee forward until a pull is felt in the calf.
• 3 × 30 seconds per side.
• Perform 1–2 × daily.

Calf and posterior thigh muscles

• Start position on all fours.
• Lift the pelvis upward.
• If possible, press the heels toward the floor to intensify the stretch.
• Hold the exercise for 3 × 30 seconds.
• Perform 1–2 × daily.

Foam rolling (Fascia rolling)
If the Achilles tendon hurts or is inflamed, treatment with a foam roller is important. Achilles tendon irritation is often caused by shortenings and tensions in the posterior chain (e.g. plantar fascia, calf and posterior thigh muscles). Regular rolling of the shortened and tense myofascial chain makes foam rolling an active therapy for irritated, inflamed and painful Achilles tendons.

Calf muscles

• One leg bent and the other leg on the foam roller. Increase pressure by placing both legs on top. Further increase by stacking the legs.
• If wrist pain occurs, the exercise can also be performed on the forearms.
• Roll the calf actively from above the heel to just below the knee crease.
• Perform exercises slowly and controlled.
• Adjust pressure to personal tolerance, but approach a tolerable pain threshold.
• Roll intensively over focal adhesions or hold the position at that point.
• At least 3 minutes per side.
• Perform 1–2 × daily.

Gluteal muscles

• Bend both legs and roll the corresponding gluteal side with a fascia ball. Increase pressure by placing one leg on top. If wrist pain occurs, the exercise can be performed on the forearms.
• Perform the exercise slowly and controlled.
• Adjust pressure to personal tolerance, but approach a tolerable pain threshold.
• Roll intensively over focal adhesions or hold the position at that point.
• At least 3 minutes per side.
• Perform 1–2 × daily.

Strengthening
Targeted strength training of the feet is particularly important for foot deformities (especially fallen, flat and pronated feet) to protect the Achilles tendons from over- and misloading. A strengthened foot and leg musculature is important in treating Achilles tendinitis and Achilles tendon pain so the tendon experiences less load. Targeted strengthening thus represents an effective therapy for Achilles tendon pain.

Foot muscles – longitudinal arch

• Stand upright with feet hip-width apart
• Heel and ball of the foot have even ground contact.
• Slowly raise the longitudinal arch without losing ground contact of the heel or ball of the foot.
• Ensure the movement comes from the feet and the lift is not caused by external rotation of the knees.
• Hold the top position for 4 seconds.
• Lower the foot slowly and controlled.
• 3 sets of 8–12 repetitions per foot.
• Perform 2–3 × weekly.

Lunge

• Start position: lunge (take a large step forward from standing).
• Feet shoulder-width apart, torso upright, abdomen engaged.
• Slowly lower the rear knee toward the ground (as deep as possible) and slowly press back up.
• Ensure the front knee is stabilized so it does not collapse inward or outward.
• Do not fully lock the knee at the top; keep a slight bend.
• Move downward, not forward. The front knee stays behind the front toes.
• If balance is a problem, hold onto a stable object with the hands.
• 3 sets of 8–12 repetitions per leg.
• Perform 2–3 × weekly.