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Achilles Tendinopathy

11 Jun Achilles Tendinopathy

Achilles Tendinopathy Part 1– Understanding the Problem

What is an Achilles Tendinopathy?

The Achilles tendon is the thick tendon connecting the calf muscles to the heel bone.  The calf muscles have a vital role in supporting their shared tendon and helping to absorb shock.

The Achilles is unfortunately vulnerable to overuse injury leading to some parts of it developing the condition known as tendinopathy.  Achilles tendinopathy is a commonly misunderstood condition, and it may be that many sufferers prolong their struggle with it because when they try to treat themselves they do the opposite to what is actually needed.

A tendinopathy is a degenerative condition and is different to the tendinitis that most people know, even though it looks and feel similar (as it can be hot, red and painful too).  The usual method for treating soft tissue injuries (rest, ice compression, elevation) doesn’t work for tendinopathies and the problem comes back worse than ever when normal activities are resumed.

What causes an Achilles Tendinopathy? 

Most Achilles tendinopathies affect either the middle of the tendon or the part of the tendon that attaches to the bone.

Early signs of the condition are pain and swelling of the tendon, and weakness of the calf muscles.  The ankle may feel stiff in the morning or after prolonged sitting. It may also feel worse the day after you have exercised.  Sometimes the pain may subside once we start exercising then return with a vengeance later in the day.

Signs of swelling and pain are your early warning that the Achilles is starting to struggle. This is commonly because your training load is exceeding the tendon’s ability to cope.  For recovery, it is essential to manage the balance between how much activity you do and how much recovery time you allow.

It is easy to overlook the effect that our lifestyles have on our training load – doing more hours at work, changing to a more manual job, walking the kids further to school for example.  All this extra activity is added to our regular training and can easily build up…before we know it we have overload on our hands!

The first step towards managing your condition is to have a look all the activity your do in an average week, so that you can start working out what needs changing to allow you to kick start your recovery.

Achilles Tendinopathy Part 2 – Getting the Treatment Right

What can you do to avoid Achilles Tendinopathy?

We know that certain factors influence the development of this troublesome complaint, such as:

  • increasing age
  • high blood pressure and increased cholesterol
  • diabetes
  • being male – men are more prone to Achilles tendinopathy than women


However, there are also plenty of factors which we can easily control to help avoid developing it.  These include:

  • maintaining a health weight
  • choosing the right footwear
  • maintaining flexible ankles and calf muscles
  • ensuring the calf muscles are strong
  • adhering to structured training programmes which incorporate rest days to allow recovery.


How can I treat myself?

If the problem is brand new, perhaps because you have just started a new activity like running, or have suddenly increased your training, the tendon may respond well to simple measures.  Try reducing the amount of exercise you are doing for a short while, add some gentle ankle movements to encourage circulation, then build up your training load more slowly when you resume your activity.

If the problem persists, research suggests the best treatment is exercise, like the one below:

Photograph credit

Lower the affected heel over a step and pushing back up with the unaffected one and repeating this cycle until your calf feels a bit tired.  Do this with the knee straight knee then with the knee bent so that both main calf muscles are exercised.

You can progress this by slowly lowering and pushing up with the affected leg alone and by gradually increasing the weight going through the tendon.  This can be done with machines in the gym or simply a weighted backpack.

Don’t worry if it is a bit painful when you do it, but ease off if the pain is severe or lasts a long time afterwards.

If your pain is just above the heel where the tendon attaches to the bone, try doing these exercises on a flat surface instead.

Repeat a set of these exercises a few times per day.  As you start to resume your usual activities, this can be dropped down to 3 days a week to avoid overloading the tendon.

What other treatments are available?

Your physio can advise you whether any other options may improve your particular problem, such as orthotics, heel lifts and taping.  Soft tissue release and joint mobilisations can also be helpful.

Final Thoughts

A message of reassurance: many people have a tendinopathy without any symptoms or restriction on their activities, include those in elite sports: the unaffected parts of the tendon are perfectly capable of compensating for the affected area.

Recovery can take months so don’t expect a quick cure, especially if you’ve had the problem a long time already, and bumps in the road to recovery are common.  However, the sooner you start to manage it, the better the outcome is likely to be.

If you are unsure whether you have an Achilles tendinopathy, or want guidance to help you recover, please contact Halo here


Blog compiled by Senior Physiotherapist, Laura Oxley

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