Pain in the Achilles tendon, particularly when lying down or at rest, is a common and often confusing issue. This discomfort can disrupt sleep and affect daily life, making simple movements challenging upon waking.
The Achilles Tendon and Pain at Rest
The Achilles tendon, also known as the calcaneal tendon, is located at the back of the lower leg. It attaches the gastrocnemius and soleus muscles of the calf to the calcaneus, or heel bone. It is crucial for movements like walking, running, jumping, and standing on tiptoes, as it enables plantarflexion, which is the action of pointing the foot downward.
Pain in the Achilles tendon can become more noticeable or worsen during periods of rest, such as when lying down. This occurs because inactivity allows the tendon to cool down and stiffen. Reduced blood flow during sleep can also contribute to this stiffness, as the tendon has a relatively poor blood supply, especially in its midsection. Many people sleep with their feet in a plantarflexed (pointed toe) position, which can shorten the tendon and lead to increased discomfort or stiffness upon waking or movement. When the body is active, muscles are warm and stretched, potentially reducing pain, but during rest, muscles can become tight and stiff, exacerbating discomfort.
Conditions Linked to Nighttime Achilles Pain
Several conditions commonly cause Achilles tendon pain that can worsen when lying down. Achilles tendinopathy, an umbrella term including tendinitis (inflammation) and tendinosis (degeneration), frequently presents with pain and stiffness after periods of inactivity or rest. This stiffness is often most noticeable first thing in the morning and may improve as the tendon warms up with use. Overuse and repetitive strain are common causes, leading to microtrauma or changes in the tendon’s structure.
Haglund’s deformity, a bony enlargement on the back of the heel bone, can irritate the Achilles tendon. This irritation can lead to inflammation and pain. Pain from conditions like plantar fasciitis, which affects the sole of the foot, can sometimes be referred to the Achilles area and worsen at night. Less commonly, nerve entrapment, where a nerve becomes compressed, can also cause heel pain that might be mistaken for Achilles issues, with symptoms like burning or tingling that can be more prominent at night.
Relief and Self-Care Strategies
Adjusting sleeping positions can help alleviate Achilles pain when lying down. Avoiding sustained plantarflexion, or pointing the toes, can prevent the tendon from shortening and stiffening overnight. Using pillows to support the foot in a more neutral or slightly dorsiflexed (toes pointing upward) position can be beneficial. Night splints or braces are specifically designed to hold the foot in a gentle dorsiflexed position, providing a prolonged stretch to the Achilles tendon throughout the night and preventing morning pain.
Gentle stretching routines performed before bed and upon waking can improve flexibility and reduce stiffness. Applying ice to the affected area can help reduce inflammation and pain. For chronic stiffness, heat therapy might be more helpful as it increases blood flow and relaxes muscles. Over-the-counter pain relievers can also provide temporary relief by reducing inflammation and discomfort.
Supportive footwear worn during the day can influence nighttime pain by reducing strain on the tendon. Shoes with good arch support, cushioned heels, and shock-absorbing midsoles are recommended. A slight heel lift in shoes can also help by reducing the load on the Achilles tendon. Choosing appropriate shoes and regularly stretching calf muscles can also contribute to preventing Achilles tendinopathy.
Knowing When to Seek Medical Advice
While self-care strategies can be effective for managing Achilles tendon pain, certain signs indicate the need for professional medical evaluation. Persistent pain that does not improve with home remedies warrants a visit to a healthcare provider. Sudden, severe pain, especially if accompanied by a popping or snapping sound, could indicate a more serious injury like a tendon rupture.
Other concerning symptoms include noticeable swelling, redness, warmth around the tendon, or any signs of infection. Difficulty bearing weight on the affected leg, an inability to stand on the toes, or significant limitation in movement should prompt medical advice. Early diagnosis and treatment can prevent the condition from progressing and reduce the risk of long-term complications.