The Achilles tendon, named after the seemingly indestructible mythological Greek warrior, is the largest and strongest tendon in the human body. Your Achilles tendon is the large band of tissues connecting the muscles in the back of your calf to your heel bone. Also called the heel cord, the Achilles tendon is used when you walk, run, jump, or push up on your toes.

Achilles tendonitis is present when your Achilles tendon becomes inflamed or irritated.Often, Achilles tendonitis results from sports that place a lot of stress on your calf muscles and Achilles tendon. Achilles tendonitis also is often associated with a sudden increase in the intensity or frequency of exercise, hence why so many endurance based athletes suffer from the condition.When treated promptly, Achilles tendonitis is often short-lived. Left untreated, Achilles tendonitis could cause persistent pain or potentially cause your tendon to tear through lack of treatment and rehab exercises. If so, you may need surgery to correct the damage. Fortunately, rest and over-the-counter medications to reduce your pain and inflammation may be all the treatment you need for Achilles tendonitis.

Signs and symptoms
The signs and symptoms of Achilles tendonitis often develop gradually. They include:

 - Dull ache or pain when pushing off your foot during walking or when rising on your toes

 - Tenderness over your Achilles tendon

 - Stiffness that lessens as your tendon warms up

 - Mild swelling or a “bump” on your tendon

 - A crackling or creaking sound when you touch or move your Achilles tendon

You may notice that the affected tendon is sore when you get up in the morning or after you’ve rested, improves slightly once you start moving around, and then worsens again when you increase your activity level.

If you have sudden pain and swelling near your heel and are unable to bend your foot downward or walk normally, you may have ruptured your Achilles tendon. If you’ve ruptured the tendon completely, you won’t be able to rise on your toes on the injured leg. You may feel as if you’ve been kicked in the back of your ankle. See your doctor immediately if you suspect you have an Achilles tendon rupture.

Causes
When you place a large amount of stress on your Achilles tendon too quickly, it can become inflamed from tiny tears that occur during the activity. A sudden increase in a repetitive activity that involves the Achilles tendon can be to blame. A number of other factors can cause Achilles tendonitis, including:

Improper conditioning
Achilles tendonitis is most common among athletes whose bodies aren’t properly conditioned for their sport or activity. Inadequate flexibility and strength of the calf muscles can contribute to overload of the tendon. Frequent stops and starts during the activity, as well as activities that require repeated jumping can also increase your risk of Achilles tendonitis.

Too much, too soon
Achilles tendonitis resulting from overuse can occur when you begin a new exercise regimen. If you’re just beginning a new exercise program, be sure to stretch after exercising, and start slowly, increasing your activity over time. Don’t push yourself too quickly. Excessive hill running can also contribute to Achilles tendonitis.

Flattened arch
Flattening of the arch of your foot (excessive pronation) can place you at increased risk of developing Achilles tendonitis. This is because of the extra stress placed on you Achilles tendon when walking. If you have excessive pronation, be sure to wear shoes with appropriate support to avoid further aggravating your Achilles tendon.

Trauma or infection
In some cases, inflammation of the Achilles tendon is due to trauma or infection near the tendon.

Complications
Achilles tendonitis can progress to a degenerative condition called Achilles tendinosis, in which the tendon begins to lose its organized structure, making the tendon weaker and more fibrous. Continued stress to your Achilles tendon could cause it to tear (rupture), which may require surgery to correct the damage.

Treatments
If you’ve tried self-care measures, such as rest, ice and over-the-counter pain relievers, and they aren’t working for you, your doctor may suggest other Achilles tendonitis treatments:

Orthotic devices
A temporary foot insert (orthotic device) that elevates your heel within your shoe may relieve strain on the stretched tendon. Your doctor also might prescribe special heel pads or cups to wear in your shoes to cushion and support your heel, or a splint to wear at night that will keep the Achilles tendon stretched while you sleep.

Boot and crutches
In severe cases, your doctor may suggest a walking boot or have you use crutches to enable the tendon to heal.

Surgery
Nonsurgical treatments, including physical therapy and perhaps a change in your exercise program, should allow the tendon to heal and repair itself over a period of weeks. If these treatments aren’t effective, surgery to remove the inflamed tissue from around the tendon may be necessary; however, this is usually a last resort.
If left untreated and if the tendon continues to sustain small tears through exercise and repeated movement, the tendon can rupture under excessive stress.

Sports Massage/Physiotherapy
A sports therapist or physiotherapist will aid you to a quicker recovery be performing massage techniques and/or ultrasound on the injured Achilles tendon in order to break up scar tissue, promote healing, and increase blood flow to the injured area. Whenever I have an injury and feel rest and stretching isn’t working I always pay a visit to my local physiotherapist. The recovery rate using a private sports physiotherapist is much quicker than going through a doctor. You may have to pay for the treatment yourself if you wish to get back to full fitness as quickly as possible, however in my opinion the benefits of such services outweigh the costs.

Prevention
While it may not be possible to prevent Achilles tendonitis, you can take measures to reduce your risk:
Increase your activity level gradually. If you’re just beginning training, don’t feel like you have to be Ironman-ready in record time. Starting slowly will help you determine your limits and follow a sensible training program.

Take it easy.
If you can, avoid other activities away from your multi-sport training that place excessive stress on your tendons, especially for prolonged periods. If you can’t avoid this, warm up first by exercising at a slower pace. If you notice pain during a particular exercise, stop and rest.

Choose your shoes carefully
The shoes you wear while exercising should provide adequate cushion for your heel and should have a firm arch support to help reduce the tension in the Achilles tendon. Replace shoes that show excessive wear. If your shoes are in good condition but don’t support your feet, try arch supports in both shoes.

Stretch daily
Take the time to stretch your calf muscles and Achilles tendon in the morning very gently and after exercise to maintain flexibility. This is especially important to avoid a recurrence of Achilles tendonitis. Use steady exercise as warmups prior to your main training session.

Strengthen your calf muscles
Performing exercises such as toe raises, especially with a slow return to the ground after each toe raise, trains the muscle-tendon unit to withstand more loading force.
Cross-train. Alternate impact activities, such as running and jumping, with low-impact activities, such as cycling and swimming.

Finally, if you are unsure of the extent of you injury, don’t hesitate to visit the doctor or a sports physiotherapist. With the limited time us muli-sport athletes have, you wouldn’t want to be out of action any longer than necessary would you!

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