Achilles Tendinopathy

What is it?

The Achilles tendon connects the calf (the back of the lower part of your leg) muscles to the heel bone. It helps you to push up on your tiptoes. Achilles tendinopathy is an injury to this tendon. If you have been diagnosed with Achilles tendinopathy, this information will help you manage it.


  • Symptoms include pain, stiffness and swelling of the back of the heel.

  • Pain is often present first thing in the morning, or when you begin to walk after resting for a period of time.

  • The pain can be variable and it can feel better as you keep moving.

  • You might notice it can be painful after lots of weight-bearing activities, such as walking or running.

  • In some cases, the tendon might be red, warm and tender to touch, and swollen or thickened in appearance.

Mechanism of Injury

Achilles tendinopathy is most often due to an overload. The tendon cannot cope with the strain being put on it. The causes of Achilles tendinopathy are not fully understood. There are many factors that can contribute to it, such as being/having:

  • Overweight

  • Tight or weak calf muscles

  • Stiff ankle joints

  • Sudden increase in activity levels, for example, running, walking or playing sports

  • Training errors, including a lack of variety in training, or too much hill running

  • On-going physical or mental health problems can contribute to the symptoms

Common Management Techniques

To help pain in the short-term, you can try the following.

  • Relative rest. Reduce activities on your feet, such as prolonged walking or running. Keep up your fitness by doing other forms of exercise, such as cycling or swimming.

  • Pain relief. You can use painkillers for short-term pain relief.

  • Ice. Wrap ice in a towel and put it on the area. This can help with pain and swelling in the early stages. Do not put ice directly onto the skin.

  • Footwear. Choose supportive footwear, rather than flat shoes.

  • Specific Physiotherapy Exercises. See other side of this sheet for home exercises.


Everybody will improve differently. For most people it will take 6 to 9 months of rehabilitation to make a return to full activities without pain.

It is normal to have some periods of increased pain, or flare-ups, during your recovery. If this happens, you can follow our tips to reduce pain in the short-term.

If your symptoms do not improve in 6 to 9 months, even when you have been completing an appropriate exercise programme, other treatment options can be considered. This includes shockwave therapy, which you can talk to your Physiotherapist about.