Achilles Tendon Pain
Pain at the back of your heel can make walking, exercising and even climbing stairs uncomfortable. It may begin after increasing your training, following a sporting injury, or develop gradually over weeks or months. Whether your symptoms are new or have been present for some time, early assessment can help identify the cause and guide the most effective treatment.
Understanding the Achilles Tendon
The Achilles tendon connects your calf muscles to your heel bone and is the strongest tendon in the body. Every step, jump and push-off relies on it to generate movement. The Achilles tendon acts like a powerful spring, storing and releasing energy to help you walk, run and jump efficiently.
Despite its strength, it is exposed to enormous forces. During walking it may experience loads of more than three times your body weight, while running can increase this to around ten times your body weight. Repeated loading without adequate recovery can exceed the tendon's ability to repair itself, resulting in injury.
Signs and Symptoms
Achilles tendon injuries can cause:
Pain at the back of the heel or lower calf
Morning stiffness or stiffness after rest
Tenderness when the tendon is squeezed
Pain during walking, running or climbing stairs
Swelling or thickening of the tendon
Difficulty rising onto your toes
Reduced sporting performance
Symptoms may develop suddenly after a specific injury or gradually over time.
What Causes Achilles Pain?
Achilles problems rarely have a single cause. Instead, several contributing factors often combine, including:
A rapid increase in running or training volume
Hill running or sprint training
Tight calf muscles
Reduced ankle flexibility
Poor lower limb biomechanics
Unsupportive or worn footwear
Returning to sport too quickly after injury
Continuing to exercise despite increasing pain
Identifying these contributing factors is an important part of successful treatment and reducing the risk of recurrence.
Understanding the Different Types of Achilles Tendon Injury
Although "Achilles tendonitis" is a term many people are familiar with, it is no longer used to describe most long-standing Achilles tendon problems. Today, the term Achilles tendinopathy is preferred because it reflects the range of changes that can occur within the tendon.
Acute Achilles Tendinitis
Acute Achilles tendinitis is an inflammatory condition that may develop following a sudden overload of the tendon. This is characterised by pain, tenderness and sometimes swelling.
During this early stage, temporarily reducing activity, ice and, where appropriate, a short course of anti-inflammatory medication may help relieve symptoms. However, progressive rehabilitation remains essential for recovery.
Achilles Tendinopathy
Most people with Achilles pain have Achilles tendinopathy rather than tendinitis. Over time, the tendon undergoes structural changes that reduce its ability to tolerate load. These changes include collagen disorganisation, thickening of the tendon and, in some cases, areas of degeneration that were traditionally referred to as tendinosis.
Achilles tendinopathy may affect the middle of the tendon (mid-portion Achilles tendinopathy) or where it attaches to the heel bone (insertional Achilles tendinopathy), with treatment varying slightly depending on the location.
Mid-portion vs Insertional Achilles Tendinopathy
The term tendinopathy is now commonly used as a general diagnosis for Achilles tendon disorders. It describes pain and dysfunction of the tendon regardless of whether inflammation or degeneration is the primary process.
Many people experience Achilles tendinopathy for extended periods, particularly if they continue participating in activities that repeatedly overload the tendon. Achilles tendinopathy most commonly develops in one of two locations, and identifying which type you have is important because treatment recommendations can differ.
Mid-portion Achilles Tendinopathy
This is the most common form of Achilles tendon pain. It affects the tendon approximately 2–6 cm above where it attaches to the heel bone. This section of the tendon has a relatively poorer blood supply, making it more susceptible to overload and slower to recover.
Typical symptoms include:
Pain or stiffness in the middle of the tendon
Morning stiffness that gradually eases with movement
Pain during or after running, jumping or longer walks
Thickening of the tendon over time
Tenderness when the tendon is squeezed
Mid-portion Achilles tendinopathy generally responds well to a structured strengthening program combined with appropriate load management.
Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy occurs where the tendon attaches directly to the heel bone. Pain is usually felt at the very back of the heel and may be accompanied by swelling or irritation from footwear. Some people also develop a prominent bony enlargement (often called a Haglund's deformity) or inflammation of the nearby bursa.
Common symptoms include:
Pain directly at the back of the heel
Tenderness where the tendon inserts into the heel bone
Pain when walking uphill or climbing stairs
Discomfort from shoes rubbing against the back of the heel
Stiffness after periods of rest
Because the tendon is compressed against the heel bone when the ankle bends upwards, treatment differs slightly from mid-portion tendinopathy. Exercises are usually modified to avoid excessive compression during the early stages of rehabilitation, while footwear changes, heel lifts and activity modification may also be helpful.
Accurately identifying the location of your Achilles injury allows us to tailor your treatment plan and select exercises that are most likely to improve your recovery.
How Is Achilles Pain Treated?
Treatment is based on the underlying diagnosis, your activity level and the factors contributing to the injury. There is no single treatment that suits everyone.
Your management plan may include:
A detailed assessment of your walking and running biomechanics
Footwear advice to reduce strain on the tendon
Targeted strengthening exercises to progressively improve tendon capacity
Calf stretching where appropriate
Activity modification to allow the tendon to recover while maintaining fitness
Orthotic therapy when abnormal foot mechanics contribute to excessive loading
Shockwave therapy for suitable chronic tendon conditions
Manual therapy to improve joint mobility where stiffness is affecting lower limb function
Research consistently shows that progressive strengthening exercises are one of the most effective treatments for Achilles tendinopathy and form the foundation of rehabilitation for many patients.
How Long Does Recovery Take?
Recovery depends on the type and severity of the injury.
A mild acute injury may settle within several weeks, whereas long-standing Achilles tendinopathy often requires several months of progressive rehabilitation. Addressing the underlying cause, rather than simply treating the pain, provides the best opportunity for a lasting recovery.
When Should You Seek Assessment?
If your Achilles pain persists for more than a few days, is worsening, or makes walking or sport difficult, it is worth having it assessed. Early diagnosis can help prevent a minor tendon injury progressing into a long-term problem.
At Renew Podiatry, we perform a comprehensive assessment to identify the specific source of your Achilles pain and develop an evidence-based treatment plan tailored to your goals, lifestyle and activity level.
FAQS
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Description text In long-standing Achilles tendinopathy, it's common for the tendon to become thickened and develop a noticeable lump. This occurs because the tendon has undergone changes in its structure as it attempts to adapt and heal over time.
The lump isn't simply "scar tissue." It usually represents an area of tendon thickening with disorganised collagen, increased ground substance and, in some cases, areas of fibrosis. These changes are typical of chronic tendinopathy.
The encouraging news is that the size of the lump doesn't necessarily reflect how painful or functional the tendon is. Many people return to walking, running and sport with little or no pain, even though the thickening remains.
Treatment focuses on improving the tendon's strength, load tolerance and function rather than making the lump disappear. While the thickening may reduce over time, particularly with a well-designed rehabilitation programme, it often persists to some degree.goes here
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Mild Achilles pain may settle with rest, but persistent symptoms often require treatment. Continuing to exercise through pain can delay recovery and increase the risk of a more significant tendon injury.
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It depends on the type of Achilles problem you have. For most cases of Achilles tendinopathy, complete rest is not recommended, and a gradual, structured loading program forms the basis of treatment. However, acute paratendinopathy may sometimes require a short period of significant activity reduction or temporary rest to allow inflammation around the tendon to settle before rehabilitation begins. Following an assessment, we'll advise you on the safest level of activity for your specific condition.
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Achilles tendinopathy commonly develops when the tendon is repeatedly overloaded faster than it can adapt. Sudden increases in walking, running or sport, calf weakness, reduced ankle flexibility, footwear changes and certain medical conditions may all contribute.
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Recovery varies depending on how long symptoms have been present and how severe they are. Mild cases may improve within a few weeks, while longstanding tendinopathy often takes 3–6 months of consistent rehabilitation.
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Current clinical practice guidelines do not recommend calf stretching as a core treatment for Achilles tendinopathy. Instead, treatment is typically based on a progressive loading programme that helps the tendon regain strength and capacity over time. For some conditions, particularly insertional Achilles tendinopathy, stretching may actually aggravate symptoms.
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Not always. Most cases can be diagnosed through a thorough history and physical examination. Ultrasound or MRI may be recommended if the diagnosis is uncertain, symptoms are not improving, or a tendon tear is suspected.
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Shockwave therapy has evidence supporting its use for some cases of chronic Achilles tendinopathy, particularly when combined with a progressive exercise program. It is generally considered when symptoms have not responded to appropriate rehabilitation alone.
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Sometimes. Orthotics may reduce strain on the tendon in selected patients, particularly where foot posture or biomechanics contribute to symptoms. They are only recommended when clinically indicated.
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Supportive footwear with an appropriate heel height can reduce strain on the Achilles tendon. Very flat or minimalist shoes may aggravate symptoms in some people, particularly during the early stages of recovery.
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Many runners can continue some level of running, provided symptoms remain within acceptable limits and the tendon is responding well. Your running load often needs to be modified while rehabilitation progresses.
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If Achilles pain persists for more than one to two weeks, is worsening, limits your activity, or develops suddenly with a popping sensation or significant weakness, you should seek assessment promptly.
Ready to take the next step?
Book an appointment with Renew Podiatry for a thorough assessment and an evidence-based treatment plan tailored to your symptoms, goals and activity level.