Achilles Tendinopathy

The Achilles tendon is located at the back of the lower leg and attaches your calf muscles to your heel bone. The tendon structure (collagen, elastin and ground substance)is disorganised and can eventually become degenerative and cysts and microscopic tears can occur. Structures around the tendon such as the bursa can become inflamed.

Symptoms: Pain and stiffness in the tendon that is usually worse first thing in the morning and eases with gentle exercise. Pain during or after sport. Eventually the tendon can become visibly swollen and thickened.

Causes: Overuse in running and jumping sports. Increase in training duration or mileage. Lack of warming up/down/stretching. Change of surface. Change of/or inappropriate footwear. Poor biomechanics of the foot and/or leg. Poor flexibility at the ankle. Generally where the tendon is not able to cope adequately with a change or increase in loading demands.

Diagnosis: Presence of the above symptoms, can be confirmed by ultra-sound or MRI.


  • Graded programme of tendon loading (calf strengthening): including full range double and single leg heel raises, proprioception, specific functional strengthening (hopping, jumping) and endurance programme and eccentric loading programme.
  • Calf and lower limb stretches (see handout in downloads).
  • Shock absorbing heel wedge or full foot insole (, also available at most online and high street retailers).
  • Advice on footwear.
  • Podiatry assessment to address foot biomechanics and provision orthotics.
  • Address faulty biomechanics at knee, hip, pelvis and lumbar spine. Specific problems would need to be assessed by a physiotherapist but some basic core stability exercises can help (see handout in downloads).
  • Acupuncture to the Achilles tendon can be very effective.
  • Therapeutic ultrasound is often effective in the early stages.
  • Steroid injections can be effective but are usually only offered following the failure of conservative management. If the steroid is injected directly into the tendon there is a risk of tendon rupture, therefore the use of an injection is only advisable if the inflammation is in the structures surrounding the tendon.

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