Achilles tendonitis and arthritis – How to tell the difference and how to treat it
- Alison Gould
- Apr 14
- 7 min read
Updated: 12 minutes ago
Is there a link between Achilles tendonitis and arthritis? Does arthritis cause Achilles tendonitis? Or can Achilles tendonitis be a sign of arthritis? Sports physio Alison Gould compares and contrasts the two conditions and gives advice on how to treat them. Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.
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Types of arthritis
We can divide arthritis into two broad categories: osteoarthritis and inflammatory arthropathies.
Osteoarthritis
Osteoarthritis is not a systemic condition – it often only affects one or two joints. Just because you have it in one joint doesn’t necessarily mean that it's going to get worse or spread to other joints.
It can affect any of the tissues that make up the joint (cartilage, bones, ligaments, joint fluid, etc.). There might periodically be some inflammation in the affected joint(s), but inflammation is not the main driver of this condition.
💡 Osteoarthritis is something that can be managed by looking at our general health and also by looking at how strong our muscles are around those joints and how flexible those joints are.
Some of the risk factors that might lead to arthritis are outside of our control, for example genetics, age, gender (it’s more prevalent in women), and previous joint surgery and injuries. Others, such as obesity, can be controlled.
Inflammatory arthropathies
Examples of these are rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, and gout. The common denominator here, and what distinguishes this type of arthritis from osteoarthritis, is the level and type of inflammatory reaction.
Other than with osteoarthritis, which is localised, the inflammation from this type of arthritis affects our system as a whole and is a main driver of the condition. So, it might not just be your heel joint that is affected here, but also some other joints or tendons. And you might experience redness and heat in the affected areas.
Often, this is the result of an auto-immune disease. To have this diagnosed correctly, you would see a rheumatologist, who would do blood tests and look into your family history and genetics.
💡 Looking after your general health, joint mobility, and muscle strength is an important part of treating inflammatory arthropathies, but medication is usually also required.
So, if you have pain, stiffness, or swelling in a joint that's lasting more than a few weeks, please see a doctor to have it checked out.
Is there a link between arthritis and Achilles tendonitis?
There is no link between osteoarthritis and Achilles tendonitis, but there is a link with inflammatory arthritis.
Enthesitis – the link between inflammatory arthropathies and Achilles tendonitis
The place where a tendon is attached to a bone is called an enthesis.
You can see in the picture below where the Achilles tendon is attached to the heel bone. There’s also a part of the joint capsule there, as well as a fat pad and a bursa (a fluid-filled sac), which act as buffers between the tendon and the heel bone when the tendon slides over or presses against the bone. All of this together make up the Achilles enthesis.
If you have one of the inflammatory arthropathies, it could cause inflammation in the Achilles enthesis, which would then be called an enthesitis.
And the symptoms of this might look and feel similar to those of Achilles tendonitis, especially an insertional Achilles tendonitis, which affects that area where the tendon is attached to your heel bone.
How can you tell the difference?
Your physiotherapist or doctor will look for clues in your medical history as well as in how your symptoms are behaving to decide whether an inflammatory condition might be to blame for your heel pain. These might include:
A family history of inflammatory arthritis or autoimmune conditions
Throbbing pain
Pain when you're just resting – this doesn't typically happen with Achilles tendonitis; there is more likely to be pain on getting up and moving again or on movement.
Pain that is disproportionately intense
Symptoms that started without any clear cause – you just woke up with it and hadn't done any unusual activity the day before.
If they suspect an inflammatory condition as part of the cause they may refer you for special tests (usually blood tests) to confirm this.
If you’ve gone for the tests for inflammatory arthropathies (assuming your pain is in the enthesis) and enthesitis has been ruled out, then you probably have insertional Achilles tendonitis.
On the other hand, if you do have enthesitis, you might still have insertional Achilles tendonitis as well.
And it’s quite tricky to tell whether this is the case, because one of the tests we would do for insertional Achilles tendonitis is to press on the area to see whether it feels tender. That tenderness can give us a clue that it's insertional Achilles tendonitis, but it also can be an enthesitis.
We would look to see whether the area might be hot, red, or swollen – that’s more likely to be inflammation which fits with enthesitis. But again, this could indicate bursitis (inflammation of the bursa). So, again, quite ambiguous.
An MRI or ultrasound scan might or might not give some clues. For example, if there is a thickening of the Achilles tendon and an increase in blood vessels and nerve endings in the tendon, we might suspect tendonitis.
However, research to compile definitive guidelines on how to distinguish between Achilles tendonitis and an enthesitis caused by an inflammatory arthropathy is still ongoing.
Treatment for arthritis-related tendonitis
If you have Achilles enthesitis caused by an inflammatory arthropathy, we have to distinguish between what is going on in your body as a whole and what is going on in your heel.
💡 The whole-body treatment is a matter for the doctor or the specialist who is treating your inflammatory arthropathy, whereas the localised treatment at the heel is quite similar to the treatment for insertional Achilles tendinopathy, whether or not you also have the latter.
Whole-body treatment
This will probably involve prescribing some sort of medication for you, such as anti-inflammatories. There are also specialised medications for specific types of inflammatory arthropathy, for example allopurinol for gout.
Localised treatment
It is useful to distinguish between treatments for short-term pain relief, which won’t fix the problem, but is always welcome, and the medium- to long-term treatment approach that get rid of your heel pain for good.
Short-term pain relief
Whenever your foot is in dorsiflexion (see picture below), your Achilles tendon is compressed against your heel bone. This is a normal movement that we can all do and get back to doing but symptoms from enthesitis or Achilles tendonitis might stop us in the short term.
However, if the tendon and/or the bursa is inflamed (whether it’s from arthritis and/or tendonitis and/or bursitis) this is going to increase the pain. It won’t worsen your injury, but it’s like constantly prodding a bruise – it might not allow the pain to calm down anytime soon if you keep on doing that.
So, here are some tips to limit the amount of dorsiflexion you subject your painful heel to:
Wear shoes with a good heel-to-toe drop, meaning that your heel is slightly higher than your toes. Most models of running shoe have a good heel-to-toe drop.
Use heel-raising shoe inserts to decrease the amount of dorsiflexion – these can be useful if you don't want to buy new shoes but your current ones don't have a high enough heel.
The Brooks running shoe models below have a 12-millimetre heel-to-toe drop, which is quite good. And here’s some heel-raising inserts as well:
Walking:
If your painful heel makes you limp when you go for long walks, use trekking poles to spread the load and to help you walk with better form.
Take shorter strides to take the strain off your Achilles tendon.
Make sure that the back of your shoe doesn’t press on or rub against the painful area. Again, heel-raising inserts might come in handy to adjust where the back of your shoe makes contact with your heel.
Ice is good for pain relief. With ice, less is more – here’s our guide on how to use ice for pain relief.
Medium- to long-term treatment
Whether or not you also have Achilles tendonitis, it is a good idea for your general health to keep your calf muscles, Achilles tendon, and the enthesis healthy.
This is where progressive strengthening exercises, consisting mostly of heel raises, come in. This approach has been shown by research to be the best long-term solution to Achilles-related heel pain.
Rather than go into detail here, I’ll refer you to our comprehensive article on exercises for insertional Achilles tendonitis – which will also be useful even if you have only arthritis in your heel.
How we can help
Need help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.