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The Achilles tendon | Diseases and pain of the Achilles tendon

The Achilles tendon owes its name to Greek mythology

In Greek mythology, Achilles faced a fate that would either see him die young and famous or live a long and insignificant life. To change this omen, his mother Thetis immersed him in the mythical river Styx, which was supposed to confer invulnerability. However, she held him by the heel, which was therefore not touched by the water and remained a weak point. This Achilles heel became a critical point not only for the mythical hero, but also for many athletes, both professional and recreational.

What is the Achilles tendon?

Anatomy of the Achilles tendon

The Achilles tendon, also known as the tendo calcaneus, is the strongest and thickest tendon in the human body. It connects the calf muscle to the heel bone (calcaneus). More precisely, it is made up of the tendons of the gastrocnemius muscle (twin calf muscle) and the soleus muscle (clod muscle), both of which are located in the lower leg.

The Achilles tendon plays a central role in many movements, especially when walking, running, jumping and climbing stairs. Its main functions include:

The Achilles tendon is an essential part of the human musculoskeletal system and enables central movement sequences such as walking, running and jumping. However, their anatomy and function also make them susceptible to various injuries and diseases that require targeted treatment to restore full functionality.

Typical diseases of the Achilles tendon

The Achilles tendon, as the strongest tendon in the human body, is particularly susceptible to various diseases and injuries. Here are some of the most common conditions that affect the Achilles tendon:

1. inflammation of the Achilles tendon (achillodynia)

One of the most common complaints is Achilles tendinitis, also known as Achillodynia. It is characterized by inflammation and pain in the Achilles tendon, often caused by overuse or repetitive strain. Typical symptoms are

2. achilles tendinopathy

Achilles tendinopathy is a degenerative disease of the tendon caused by chronic overloading. It is divided into two main forms, which are described below.

3. rupture of the Achilles tendon

A complete or partial rupture of the Achilles tendon is a serious injury that often occurs during sudden, intense movements such as sprinting or jumping. An Achilles tendon rupture is characterized by a sudden, sharp pain in the back of the lower leg or heel.

4. haglund syndrome

Haglund’s syndrome is a bony protrusion on the back of the calcaneus that leads to Achilles tendon irritation and irritation of the surrounding tissue. This irritation can lead to inflammation and pain.

5. bursitis (inflammation of the bursa)

Bursitis can also cause pain in the Achilles tendon area. It is caused by inflammation of the bursae, which are located between the Achilles tendon and the heel bone, and manifests itself as pain in the back of the heel, swelling and redness in the area of the bursae and tenderness.

Causes and frequency of Achilles tendon pain

Causes and frequency of Achilles tendon pain

Achilles tendon pain is usually caused by overuse and accounts for a fifth of problems in runners and 5% of complaints in all athletes. Typically, this pain occurs (except in competitive athletes) in middle-aged men who play recreational sports at the weekend. Several factors contribute to the high frequency of these complaints:

The main factor for the development of degenerative processes in the tendon is overloading, which causes pathological changes (tendinopathy).

Achilles tendinopathy

Achilles tendinopathy

A common musculoskeletal disorder

A differentiation of the clinical picture

In order to better differentiate the clinical picture, a subdivision into attachment tendinopathy and non-attachment tendinopathy was introduced in 1992.

Clinical diagnosis and differentiation

During the clinical examination, Achilles tendinopathy must be differentiated from ankle joint disorders or bursitis, for example. Attachment tendinopathy is present if the changes in the tendon and the pain are localized within 3 cm of the attachment point of the tendon. Patients often report pain when standing on their toes, but sometimes pain that interferes with walking and normal daily activities. In addition to X-rays, magnetic resonance imaging is important for investigating the presence and extent of tendon degeneration.

Treatment of Achilles tendinopathy

Conservative treatment

Conservative treatment of chronic attachment tendinopathy is less successful than for tendinopathy outside the attachment. Eccentric exercises or stretching of the calf muscle are less likely to help. Other conservative measures include:

The local application of cortisone is not recommended, as it further weakens the tendon and can lead to a tear at the attachment site.

Surgical treatment

If conservative treatment fails for at least 6 months and the symptoms are significant, a surgical solution may be considered. The choice of surgical technique depends on the degree of Achilles tendon degeneration.


Achilles tendon disorders, especially tendinopathies, are a common and often painful challenge for athletes. The correct diagnosis and targeted treatment are crucial to alleviate the symptoms and enable a full recovery. Whether conservative or surgical treatment – individual therapy planning is essential to achieve the best possible results.