Should I get a steroid injection for Achilles pain?

Steroid injections into the Achilles tendon can weaken it and raise the risk of rupture, so we generally avoid them. We use options designed to support the tendon, such as loading programs, PRP, tendon scraping, and percutaneous tenotomy.

Is insertional Achilles pain treated differently?

Yes. Pain where the tendon attaches to the heel often does better when exercises avoid deep stretching over the heel edge early on. We tailor the loading program and procedures to where the tendon is affected.

Can PRP help an Achilles tendon tear?

PRP can support healing of Achilles tendinopathy and small partial tears. A complete rupture is a different injury and is managed by a surgeon or with specialized bracing, and we help coordinate that care.

Can I keep running with Achilles tendinopathy?

Many people can keep running at a reduced level while they strengthen the calf. Pain should stay mild during the run and settle by the next morning, and we adjust from there.

Achilles Tendinopathy and Tenosynovitis: Non-Surgical Orthopedic Treatment in Bethesda, MD

About Achilles tendinopathy and tenosynovitis

The Achilles tendon links the calf to the heel bone and handles very large forces with every step, jump, and sprint. When it is loaded faster than it can adapt, the tendon can become painful, thickened, and stiff. This can happen in the middle of the tendon or at the insertion, where it meets the heel.

Tenosynovitis refers to irritation of the thin sheath around the tendon, which can occur alongside tendinopathy. Achilles problems are common in runners and court-sport athletes, and they also appear in people who are not especially active, sometimes related to age, weight, or certain medications.

The tendon gets stronger with the right load, so the aim is to keep you moving while you rebuild calf and tendon capacity.

Anatomy diagram of the lower leg muscles, including the calf muscles joining the Achilles tendon. — The calf muscles join to form the Achilles tendon, which attaches to the heel bone.

Common symptoms

Pain and stiffness in the Achilles tendon, especially first thing in the morning
Pain at the back of the heel where the tendon attaches
A thickened or tender area along the tendon
Pain that eases during a warm-up but returns later
Pain with hills, stairs, or pushing off

Common causes and risk factors

A sudden increase in running, speed work, or hill training
Weakness or poor endurance in the calf muscles
Changes in footwear or training surface
Certain medications, such as fluoroquinolone antibiotics
Age-related tendon changes and conditions such as diabetes

How we diagnose it

Our physicians examine the tendon and calf and use diagnostic ultrasound at the exam table to see exactly where the tendon is affected. Ultrasound shows thickening, damaged tissue, small partial tears, calcium at the insertion, irritation of the tendon sheath, and bursitis at the back of the heel. A sudden pop with weakness pushing off suggests a complete rupture, which needs prompt surgical evaluation.

How Propel treats Achilles tendinopathy and tenosynovitis

We start with a progressive calf and tendon loading program, adjusted for whether the pain is in the middle of the tendon or at the heel. Running and training are modified rather than stopped, and we address footwear, recovery, sleep, and nutrition. Most people improve with this approach.

When pain persists, ultrasound-guided PRP can support tendon healing, and tendon scraping frees the tendon from irritated surrounding tissue and small nerves. Dr. Gruner performs percutaneous tenotomy (Tenex), which removes damaged tendon tissue so healthy tissue can regenerate. For resistant pain, Dr. Chen offers ultrasound-guided nerve ablation to quiet the pain-carrying nerves.

All lower leg, foot and ankle procedures

What to expect at your visit

1.
We listen first
Your visit opens with a real conversation: how the problem started, what you have already tried, and the activity you want back.
2.
Exam and in-office ultrasound
A hands-on exam, then ultrasound at the exam table, often while you move, so your physician can see the tendon, joint, or nerve involved.
3.
A clear diagnosis and plan
You leave knowing what is wrong and what your options are, from strength-based rehab to procedures, and why we recommend each one.
4.
Treatment and follow-through
Most procedures happen here in the office. We coordinate with your physical therapist and check progress against the goals you set.

Rehab protocols

Dr. Gruner's week-by-week recovery guidelines. Your plan is individualized; follow these with your physician and physical therapist.

Clinical evidence

Published studies our physicians draw on. Results in studies do not predict any one person's outcome.

Questions about Achilles tendinopathy and tenosynovitis

Should I get a steroid injection for Achilles pain?: Steroid injections into the Achilles tendon can weaken it and raise the risk of rupture, so we generally avoid them. We use options designed to support the tendon, such as loading programs, PRP, tendon scraping, and percutaneous tenotomy.
Is insertional Achilles pain treated differently?: Yes. Pain where the tendon attaches to the heel often does better when exercises avoid deep stretching over the heel edge early on. We tailor the loading program and procedures to where the tendon is affected.
Can PRP help an Achilles tendon tear?: PRP can support healing of Achilles tendinopathy and small partial tears. A complete rupture is a different injury and is managed by a surgeon or with specialized bracing, and we help coordinate that care.
Can I keep running with Achilles tendinopathy?: Many people can keep running at a reduced level while they strengthen the calf. Pain should stay mild during the run and settle by the next morning, and we adjust from there.

Why does my Achilles tendon hurt, and how can I treat it without surgery?