Most people take antibiotics expecting to feel better within days.
Very few expect to develop severe tendon pain that limits their ability to walk.
Recently, we worked with a patient who developed bilateral Achilles tendinopathy after being prescribed Ciprofloxacin (Cipro) — a fluoroquinolone antibiotic known, in rare cases, to affect tendon health.
While uncommon, medication-induced tendinopathy is real — and it can happen to anyone.
How It Started
Shortly after beginning Cipro, the patient developed pain and stiffness in both Achilles tendons.
The discomfort escalated quickly:
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Burning and tightness in the heels
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Morning stiffness
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Pain with walking
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Progressive weakness
Once he learned about the potential side effects, he stopped the medication under medical guidance.
His plan?
Rest completely and wait for it to calm down.
The Rest Trap
For six months, he avoided activity — no walking for exercise, no loading the calves, minimal movement overall — hoping time alone would fix the issue.
While rest can help in the very acute phase, tendons do not regain strength without progressive loading.
After half a year:
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He could not walk more than 0.3 miles without significant, life-limiting pain
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Ankle mobility was restricted
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Foot and calf strength had noticeably declined
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Confidence in movement was low
He later began traditional physical therapy, which improved symptoms slightly — but he still didn’t feel functional.
That’s when he decided to seek a more comprehensive approach.
Our 8-Week Integrated Plan
We combined:
Shockwave Therapy
Radial shockwave was used to stimulate local blood flow and promote tendon remodeling. This modality can be helpful in chronic tendinopathy cases where the tendon has failed to properly heal.
Chiropractic Care
Joint restrictions at the ankle, foot, and lower kinetic chain were addressed to improve biomechanics and load distribution.
Progressive Physical Therapy
This was the foundation:
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Controlled isometrics
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Gradual calf loading
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Foot intrinsic strengthening
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Ankle mobility restoration
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Progressive walking tolerance
No random exercises.
No aggressive overstretching.
Just structured, progressive loading.
The Missing Link: Foot Strength & The Toes
One of the biggest deficits we noticed early on was poor intrinsic foot strength and toe control.
When the foot cannot stabilize effectively:
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The Achilles absorbs more strain
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The calf complex overworks
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Tendon irritation persists
We incorporated the ToePro into his rehab program to specifically target:
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Toe flexion strength
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Short foot activation
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Arch stability
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Controlled loading through the plantar fascia–Achilles complex
The ToePro allowed us to:
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Load the foot in a measurable, progressive way
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Improve toe flexor strength without aggravating symptoms
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Rebuild the foundation before increasing walking volume
As his foot strength improved, we noticed:
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Decrease levels of daily pain
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Reduced strain through the mid-portion of the Achilles
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Improved tolerance to longer walking distances
Strengthening the “bottom of the chain” helped unload the tendon from the ground up.
The Results
At the start:
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Walking tolerance: 0.3 miles
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Significant pain
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Limited ankle mobility
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Weak intrinsic foot strength
After 8 weeks:
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Walking tolerance: 1.5 miles comfortably
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Little to no tendon pain
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Improved ankle mobility
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Stronger calves and feet
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Restored confidence in movement
The key wasn’t just one treatment.
It was the combination of:
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Stimulating healing
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Restoring joint mechanics
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Strengthening the foot tripod
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Gradually rebuilding tendon capacity
A Rare But Real Risk
Fluoroquinolone antibiotics like Ciprofloxacin have been associated — in rare cases — with tendon inflammation and even rupture.
Risk factors can include:
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Age over 60
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Corticosteroid use
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Renal dysfunction
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High activity levels
But it can also occur in otherwise healthy individuals.
If you ever experience new tendon pain while taking this class of medication, speak with your prescribing physician immediately.
The Takeaway
Tendons need load to heal.
Too much load irritates them.
Too little load weakens them.
The goal is the right amount — progressed at the right time.
Medication-induced tendinopathy can feel discouraging, especially when rest alone doesn’t work. But even chronic cases can improve with a strategic, movement-based approach.
Sometimes, strengthening something as small as your toes can make a big difference in how your Achilles feels.
Movement — done correctly — is often the medicine.
