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The Achilles tendon connects the main calf muscles in the leg to the heel bone (calcaneum) in the foot. Achilles tendonitis is caused by repetitive stress of the tendon, including from a sudden increase in the amount or intensity of exercise activity, an increase in weight, tight calf muscles or a bone spur at the back of the heel. It usually presents as pain, stiffness and swelling along the Achilles tendon which is worse in the morning and aggravated with activity. Pain localised to the back of the heel bone can indicate Achilles insertional tendonitis (inflammation of the tendon insertion onto the calcaneum). Over time, this can progress to chronic degeneration of the tendon which can be asymptomatic or continue to cause dysfunction and predispose to rupture. Alternatively, a spontaneous Achilles tendon rupture can also occur, typically during a sporting activity (non-contact, trivial and without prodromal symptoms) and classically in the male ‘weekend warrior’.