ACHILLES TENDONITIS

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Achilles tendonitis is one of the most common causes of heel pain in Singapore, affecting active individuals across all ages — from weekend recreational runners at MacRitchie Reservoir to office workers who spend long hours on their feet. The condition involves inflammation of the Achilles tendon, the largest and strongest tendon in the body that connects the calf muscles to the heel bone and powers everyday movements such as walking, running, and climbing stairs. When this tendon becomes overloaded or irritated through repetitive activity, sudden increases in exercise intensity, or contributing health conditions such as diabetes, the resulting pain can range from a dull morning ache to severe discomfort that limits daily function.

Left unmanaged, Achilles tendonitis can progress to tendon degeneration or even a complete rupture — a serious injury requiring prolonged recovery. Early, accurate diagnosis is therefore essential. 

At Singapore Paincare, our specialists provide minimally-invasive treatments that relieve pain safely and effectively—offering an alternative to long-term medication or open surgery, often with little to no downtime. Our goal is to help you return to your daily activities with comfort and confidence.

Achilles-Tendinitis

What are the Causes of Achilles Tendonitis?

Achilles tendonitis develops when the tendon is subjected to more load or repetitive stress than it can tolerate. Causes fall into two broad categories — mechanical and non-mechanical. 

Mechanical Factors

  • Running and High-Impact Sports: Athletes who participate in sports such as sprinting, basketball, badminton, soccer, and gymnastics are at significantly elevated risk. Studies show an injury incidence of up to 24% in athletes who engage in these activities. In Singapore, where recreational sports participation is high and facilities like sports halls and running tracks are widely accessible, overuse injuries of this type are especially prevalent. 
  • Direct Trauma: A sudden impact or awkward landing — whether from jumping, a misstep on uneven ground, or a sports collision — can impose excessive pressure on the heel and trigger acute inflammation of the tendon. 
  • Obesity: Carrying excess body weight places increased stress on the Achilles tendon with every step taken. Even modest weight gain can meaningfully raise the risk of tendon inflammation, particularly when combined with physical activity. 

Non-Mechanical Factors

  • Muscle Weakness, Imbalance, or Ankle Instability: Biological and structural factors such as an anatomical variation of the plantaris muscle, lateral ankle instability, or an uneven distribution of weight across the foot can place chronic stress on specific parts of the tendon, predisposing it to inflammation over time. 
  • Medical Conditions: Systemic conditions such as diabetes mellitus can increase susceptibility to Achilles tendonitis. Long-standing diabetes can lead to glycosylation of tendon fibres, resulting in progressive stiffness and weakness that makes the tendon more vulnerable to injury. 
  • Age and Gender: Achilles tendon injuries are statistically more prevalent in men than in women, and the risk increases with age as the tendon naturally loses elasticity and resilience. Middle-aged recreational athletes  often called 'weekend warriors' — represent a particularly common group seen in our clinics. 

What are the Symptoms of Achilles Tendonitis?

Achilles Tendonitis symptoms can range from manageable discomfort to deeply debilitating pain that impacts daily functions. If condition is severe or persistent, it's best to have it checked by a pain specialist.  

General Symptoms of Achilles Tendonitis

  • Heel Pain: Pain is a hallmark symptom, often severe in the morning. It can be felt anywhere along the tendon's path, from the heel up to the calf. While it may improve somewhat with motion, it typically worsens with increased activity. 
  • Stiffness and Tenderness: The affected area is likely to feel tender, swollen, and stiff due to inflammation. 
  • Limited Range of Motion: Inflammation can restrict movement, causing difficulties in bending your ankle or walking comfortably. 

When to Seek Expert Medical Attention

You should seek consultation with a pain specialist when you experience any of the following, as they indicate a need for professional diagnosis and early intervention: 

  • Pain or stiffness at the back of the heel 
  • Mild aches at the back of the heel 
  • Tenderness near the affected area 
  • Pain in the middle of the tendon. Associated with swelling and oedema 
  • Limited Range of motion 

What Are the Options for Achilles Tendonitis Treatment in Singapore?

Conservative Treatments

  • Orthotics: Doctors may recommend shoe inserts, which can be standard-sized or custom-made, to help correct foot problems, improve weight distribution, and reduce stress on the tendon. This provides mechanical support to the foot structure. 
  • Physiotherapy: A physiotherapist will tailor a variety of exercises to improve the elasticity, strength, and support of the feet and ankles. Targeted muscle exercise is crucial to reduce pain, improve tendon tolerance, and prevent damage from worsening. 
  • Non-Steroidal Anti-Inflammatory Drugs (NSAIDs): Over-the-counter or prescription pain medications can be used to temporarily relieve pain and reduce inflammation associated with the condition. 
  • Extracorporeal Shock Wave Therapy (ESWT): This procedure involves applying high-energy sound waves to the affected area. The shockwaves stimulate a metabolic reaction and promote a healing response in the damaged tendon tissue. 

Minimally Invasive Procedures

If your symptoms do not improve or continue to interfere with movement, minimally invasive treatments can target the real source of pain without the need for open surgery. At Singapore Paincare, we offer precise procedures designed to relieve pain at its origin.

  • Platelet-Rich Plasma Injection Therapy: This treatment involves injecting a concentration of the patient’s own platelets into the affected area. The concentrated platelets are rich in growth factors which can help reduce inflammation and swelling in the bursa and the tendonitis, promoting cellular repair and healing. Early treatment with Platelet-Rich Plasma injection is highly recommended to prevent the progression of tears or rupture. 

Surgical Treatment

Surgery is rarely required for Achilles tendonitis and is considered only when conservative and minimally invasive treatments have failed after an appropriate period — typically six months to a year — or when imaging confirms significant structural damage such as severe tendon degeneration or partial rupture. 

  • Foot Surgery makes an incision at the back of the ankle to remove any infected area of the tendon and then stitches or sews up the frayed ends of the tendon tears. It is important to note that surgery carries associated risks, potential complications, and a long downtime—up to 4 to 6 months in a cast—and may not be suitable for all patients. 

How Does Singapore Paincare Treat Achilles Tendonitis?

At Singapore Paincare, our specialists use the proprietary Painostic® method, developed from years of clinical experience. This in-house approach goes beyond standard assessment to identify the real source of your pain and map treatment pathways tailored specifically to your condition. 

We focus on the least invasive options first, including targeted injections and minimally invasive procedures, often supported by medication and physical or cognitive rehabilitation. Even in complex or persistent cases, this integrated approach helps relieve pain, improve mobility and reduce the risk of recurrence. 

How to Prevent Achilles Tendonitis？

You can significantly reduce your risk of developing Achilles tendonitis by adopting preventative measures, particularly in a high-activity lifestyle common in Singapore:

  • Doing a Proper Warm-up: Always perform a proper warm-up before engaging in any exercise or sports activity to prepare the tendon for stress. 
  • Varying Exercises: Incorporate a variety of exercises to avoid repetitive stress on the Achilles tendon, which can lead to overuse injuries. 
  • Maintaining Muscle Activity: Keep your muscles active and strong, focusing on the calf and surrounding supporting muscles. 
  • Wearing Proper Footwear: Always wear shoes that fit well and are appropriate for the activity you are undertaking. 
  • Choosing Appropriate Terrain: Avoid running uphill or on uneven ground, which places excessive and sudden strain on the Achilles tendon. 

FAQs About Achilles Tendonitis

Achilles tendonitis refers specifically to acute inflammation of the Achilles tendon, typically characterised by pain, swelling, and tenderness that develops over a relatively short period due to overuse or sudden injury. Achilles tendinopathy is a broader term that encompasses both acute tendonitis and chronic degenerative changes within the tendon — where the tendon tissue has lost its normal structure and may no longer exhibit significant inflammation. Tendinopathy tends to be more stubborn to treat and takes longer to heal. At Singapore Paincare, our diagnostic approach allows us to distinguish between these presentations and tailor treatment accordingly.

Untreated Achilles tendonitis can progress through several increasingly serious stages. Ongoing inflammation, combined with continued mechanical loading, causes micro-tears to form within the tendon fibres. Over time, these micro-tears accumulate into a larger structural gap, ultimately resulting in a partial or complete tendon rupture. Once a complete rupture occurs, surgical repair is often necessary, followed by up to four to six months of immobilisation and rehabilitation. Early intervention is therefore strongly recommended — the sooner the condition is addressed, the better the outcomes and the lower the risk of irreversible damage.

In mild cases, walking is generally tolerable, but it is important to listen to your body and avoid activities that sharply increase pain. High-impact activities such as running, jumping, or sports that require sudden direction changes should be reduced or temporarily avoided to allow the tendon to recover. Lower-impact alternatives such as swimming or cycling can help you maintain fitness without adding stress to the tendon.

Minimally invasive treatments for Achilles tendonitis are typically performed as outpatient procedures with minimal downtime. Most patients are able to return to light daily activities within one to two days. Some temporary soreness at the injection site is normal and usually resolves within a few days. 

A Message About Achilles Tendonitis from Our Pain Specialist 

Achilles tendon pain may start as a mild ache, but if ignored it can affect how you walk, exercise, or even stand comfortably. Everyday factors like repetitive stress, sudden increases in activity, poor footwear, or tight calf muscles can trigger it. If left untreated, the tendon may become inflamed, stiff, or develop micro-tears — potentially leading to partial or complete rupture. 

Many people assume heel or foot pain always points to simple strain or ageing. In reality, Achilles tendonitis is often the real cause, and deeper issues such as tendon degeneration, muscle imbalance, or poor biomechanics may be involved. That's why the first step is always to find out exactly where your pain comes from. 

At Singapore Paincare, our Painostic® method goes beyond treating symptoms. We identify the real source of discomfort and build an individualised, minimally invasive plan—so you can eat comfortably, sleep well, and return to your daily life with confidence.