• Calcification in Achilles Tendon is a condition that causes the hardening of the Achilles tendon due to calcium buildup.
• This condition can cause pain, stiffness, and limited ankle joint movement.
• Exercise can help improve the Achilles tendon’s strength, flexibility, and overall health, reducing calcification symptoms.
• Working with a healthcare professional to design a safe and effective exercise program that meets your individual needs is important.
• The exercises may include stretching, strengthening, range of motion exercises, and low-impact activities such as swimming or cycling.

Pain and swelling just behind the ankle joint could be due to calcification in the Achilles tendon. The Achilles tendon can be calcified due to various factors, including injury, ageing, or a medical condition. The sufferer of this kind of pain usually complains of pain at this particular point and difficulty in walking or stair climbing.

In this blog post, we’ll explore calcification in the Achilles tendon, its causes, symptoms, and exercise treatment options.

Calcification in Achilles tendon

Calcification of the Achilles tendon occurs when there is an abnormal deposition of calcium leading to the formation of extra bone where the tendon inserts into the heel bone. In some cases, it can extend into the main body of the tendon, causing calcific tendinopathy of the main body².

Though there could be other causes of pain at the back of the heel, like calcaneal bursitis and Haglund’s deformity, the common cause is retrocalcaneal tendinitis with calcification.

What causes calcific Achilles tendon

The exact cause is unknown, but if the Achilles tendon insertion is continuously subjected to stress and stretch for days and months, it results in irritation at his point. This slowly, with time, develops swelling and calcification, leading to a calcified Achilles tendon.

Previous research also revealed that, as a person ages, the likelihood of developing ICT rises, especially for those who have diabetes mellitus and hypothyroidism¹.

There could be one of the two factors, intrinsic cause or extrinsic cause, or both factors simultaneously working to give irritating stress at an insertional point on the back of the calcaneum.

Intrinsic cause

Some of the intrinsic factors that can lead to calcification of the Achilles tendon include old internal injuries, tightness or contracture of the muscle or tendon, and deformity in the muscle or tendon. Old internal injuries can cause calcium deposits to accumulate in the tendon over time. Tightness or contracture of the muscle or tendon can cause stress on the tendon, which can lead to calcification. Deformity in the muscle or tendon can also cause stress on the tendon, leading to calcification.

1. Tendo Achilles tightness.
2. Hamstring tightness
3. Flat foot: When the arch is flat, the front of the heel bone is tilted lower than normal, while the back of the heel is tilted a bit higher. This may force the posterior-superior portion of the heel into the Retrocalcaneal Bursa and Achilles Tendon.

4. Pronated foot: A pronated foot is a type of foot deformity where the arch of the foot collapses and the foot rolls inward. This can cause pain, discomfort, and problems with balance and stability. People with pronated feet may benefit from special shoes or orthotics to provide support and correct their foot position.

5. Genu valgum: Genu valgum, also known as knock knees, is a common knee deformity where the knees angle inward and touch each other when the legs are straightened. This may be due to various reasons, such as a developmental problem in childhood, injury, or a genetic condition. The condition may cause prolonged pain, discomfort, and difficulty walking, running, or standing. Treatment options may vary depending on the severity of the condition and may include physical therapy, braces, or, in severe cases, surgery.

Extrinsic factor

Extrinsic factors that can cause calcification of the Achilles tendon include overuse of the tendon, improper footwear, and poor training techniques. Overuse of the tendon can cause repetitive stress on the tendon, leading to inflammation and eventual calcification. Improper footwear can also cause stress on the tendon, leading to calcification. Poor training techniques can cause improper alignment of the body, leading to stress on the Achilles tendon and eventual calcification.

1. Activities which involve excessive jumping and running.
2. Dancing
3. Cycling
4. Trauma/ injury
5. Gastrosoleous muscle weakness/inefficiency.

Symptoms & clinical features of calcified Achilles tendon

A calcified Achilles tendon is a condition where calcium builds up in the tendon, causing it to harden and become less flexible. This can lead to pain, stiffness, and reduced mobility in the affected leg. Symptoms of a calcified Achilles tendon may include aching or sharp pain in the back of the heel or ankle, difficulty walking or running, and tenderness or swelling in the area.

• Pain during running, prolonged jumping.
• Strenuous activity/athletic activity on hilly surfaces.
• Inability to participate in athletic activities.
• As it progresses, one complains of pain & stiffness resolving with movement and activities.

• Restriction of Dorsi Flexion of ankle
• Localised nodule/ swelling.
• Strong resisted plantar flexion is painful.

Treatment of Achilles tendon calcification

During physiotherapy treatment, a physical therapist will use various techniques to help reduce inflammation and improve range of motion. This may include manual therapy, such as massage and stretching, as well as exercises to strengthen the muscles in the affected area. In addition to these techniques, a physical therapist may also recommend using orthotics or other supportive devices to help alleviate pressure on the Achilles tendon.

They may also advise on lifestyle changes, such as modifying footwear or adjusting exercise routines, to help prevent further injury.

Physiotherapy aims to prevent further damage, resolve inflammation, and prevent reoccurrence. Physiotherapy treatment can be categorised into the acute phase and chronic phase.

Acute phase

• Rest
• Avoid precipitating activities like running, and jumping.
• Cryotherapy/ ice therapy

Subacute/chronic phase

• DTFM (Deep Transverse friction Massage)- done to smoothen the nodule.
• Stretching of tendo Achilles done.

• Ultrasonic therapy.
• Ice therapy.
• Strengthening exercise

Achilles Heel Guard: comfortably protects the back of the heel and the lower portion of the Achilles tendon from shoe pressure and friction.

Some time appropriate footwear modification is done

Calcification of the Achilles tendon can be a debilitating condition, but modifying footwear can be an effective way to manage it. It’s crucial to use shoes with a slightly raised heel or cushioned sole to reduce stress on the tendon and alleviate pain. Proper shoe fit is also essential.

Shoes that are too tight or too loose can exacerbate the condition and cause additional discomfort. It’s important to choose shoes that provide ample support and cushioning while also allowing for proper foot and ankle movement.

If the calcification is severe, a podiatrist may recommend custom orthotics to be worn on the shoes. These specially designed inserts provide additional support and cushioning to the foot, making them a valuable option for those struggling with this condition.

Exercises for Achilles tendon calcification

Research suggests that eccentric heavy load is beneficial in curing this tendinopathy. We recommend slowly progressing from light stretching exercises to heavy-load exercises³.

We have a dedicated article on this topic, we recommend referring to “Easy Achilles tendonitis stretches and other exercises for Pain Relief” for a comprehensive guide.

Final Word

In this problem, the first conservative treatment (Physiotherapy) is tried. If conservative treatment does not respond then surgery is the only option left.

Keep Reading: How to Contrast Bath Therapy for Hand & Foot Swelling

Sunit. S. Ekka

Dr Sunit Sanjay Ekka is a physiotherapist in practice for the last 15 years. He has done his BPT from one of the premium Central Government physiotherapy colleges, ie, SVNIRTAR. The patient is his best teacher and whatever he gets to learn he loves to share it on his Youtube channel and blog.