Except in cases of acute tears, people with Achilles tendon problems usually experience a gradual worsening of pain. The pain usually first appears with strenuous physical activity, such as running and playing sports, and may progress until it accompanies normal walking. In severe cases, the pain may be felt even at rest.
Patients may have Achilles tendinopathy if they display one or more of the following symptoms:
- Pain that is associated with use. Pain may be localized to the Achilles tendon, particularly in the lower calf where the tendon and muscle tissue meet. Less commonly pain is felt where the tendon inserts into the calcaneus (heel bone).
- Swelling and stiffness at the site of the Achilles tendon, especially where it meets the heel. This stiffness may be more noticeable in the morning.
- Redness and warmth of the skin overlying the Achilles tendon. This area may also feel tender to the touch.
- Reduced strength in the lower leg and/or ankle.
- Reduced range of motion in the ankle. It may be more difficult to fully flex the ankle.
- Presence of a Hagland’s deformity, which is a bony formation on the back of the heel (also called a “pump bump”).1
As symptoms grow worse over time, a person may have difficulty standing, walking, or running.
Are Symptoms Caused by the Achilles Tendon or a Bursa?
The symptoms associated with Achilles tendonitis and related conditions have some overlap with the symptoms associated with bursitis at the back of the heel. Two common types of heel bursitis, called retrocalcaneal bursitis or retroachilles bursitis, can occur separately or in addition to Achilles tendon problems.
The retrocalcaneal bursa is located behind the Achilles tendon, just above where the tendon attaches to the heel bone. When this bursa is inflamed (bursitis) it will cause visible soft tissue swelling near the top of the heel bone. Patients with retrocalceanal bursitis will have pain in front of the Achilles tendon and just above the heel bone. This pain can be reproduced by manually squeezing the heel.
The retroachilles bursa is located between the Achilles tendon and skin. The symptoms of retroachilles bursitis are slightly different than the symptoms of retrocalcaneal bursitis. Swelling may be more distinct, appearing as a hard lump behind the heel. Retroachilles bursitis is also more likely than retrocalcaneal bursitis to cause the skin at the back of the heel to turn red.2