Achilles Tendinopathy (back of ankle pain)
Achilles pain that’s stiff in the morning and flares when you run? This is one of the most treatable tendon conditions - with the right approach
Achilles tendinopathy responds well to structured rehabilitation and, in persistent cases, focused shockwave therapy. The key is understanding which type you have - mid-portion or insertional - because they behave differently and require different management. We use ultrasound to confirm this from the start.
What is Achilles tendinopathy?
Achilles tendinopathy is a common cause of persistent pain at the back of the ankle or heel. It involves irritation or degeneration of the Achilles tendon - the strong tendon that connects the calf muscles to the heel bone and plays a key role in walking, running, and jumping. The Achilles tendon joins the calf muscles to the heel bone. It stores and releases energy during walking and running, and is subjected to very high loads, particularly during foot push-off.
Despite often being described as an “inflammatory” condition, Achilles tendinopathy is usually not a true inflammatory problem, particularly when symptoms have been present for several months. In longer-standing cases, the issue is more accurately related to tendon overload, structural change, and reduced healing capacity rather than active inflammation.
Common Symptoms
Symptoms vary, but often include:
- Pain or stiffness at the back of the ankle or heel
- Pain that worsens with walking, running, or climbing stairs
- Stiffness or discomfort on the first steps in the morning
- Pain that is worse after periods of rest and improves slightly with initial movement
- Tenderness when pressing into the tendon or heel
- A feeling of tightness or weakness in the calf
Symptoms may affect one or both sides.
Who does it commonly affect?
Achilles tendinopathy can affect anyone, but it is particularly common in:
- People who walk or stand for long periods
- Runners and recreational athletes
- Individuals who have recently increased training or activity levels
- People returning to activity after a period of rest or injury
- Those with reduced ankle mobility or altered lower-limb mechanics
- People wearing unsupportive or worn footwear
Symptoms may develop gradually and often without a single obvious injury.
Types of Achilles tendinopathy
Not all Achilles tendon pain is the same. The location of symptoms is important, as it influences both management and rehabilitation.
Mid-portion Achilles tendinopathy
This affects the tendon a few centimetres (2-6cm) above the heel bone.
It is commonly associated with:
- Running or jumping activities
- Training load increases
- Tendon thickening or tenderness when squeezed
This type typically responds well to progressive loading exercises and, where appropriate, focused shockwave therapy.
Insertional Achilles tendinopathy
This affects the tendon where it attaches directly into the heel bone.
It is often associated with:
- Pain at the back of the heel
- Discomfort when wearing rigid or tight footwear
- Increased sensitivity to compression and uphill walking
Insertional Achilles tendinopathy often requires more careful load management and specific rehabilitation strategies, as the tendon behaves differently at the attachment site.
How is Achilles tendinopathy usually treated?
Most cases improve with appropriate conservative care, but this often requires a combination of approaches rather than a single treatment.
Common elements include:
- Load management and activity modification (reducing excessive strain on the tendon in daily activities)
- Targeted strengthening exercises (rehabilitation exercise) to improve tendon load tolerance
- Addressing calf strength, ankle mobility, and lower-limb mechanics
- Footwear advice and activity pacing
- Manual therapy where appropriate
For persistent or long-standing symptoms that have not settled with time or basic care, focused shockwave therapy is commonly used to help stimulate tissue healing and recovery. Focused shockwave therapy is more comfortable than radial shockwave therapy, typically more effective, and usually requires fewer sessions overall. To learn more about these therapies, please click on the in-text links.
With appropriate loading, rehabilitation, and targeted treatment, most people with Achilles tendinopathy can return to walking, running, and sport without ongoing pain.
Why our approach is different
At Tenby Health & West Wales Ultrasound, we focus on understanding the problem properly before deciding on treatment. Where clinically appropriate, we use diagnostic ultrasound to assess the Achilles tendon, confirm whether changes are mid-portion or insertional, and rule out other causes of posterior ankle or heel pain.
This allows treatment to be targeted and appropriate, rather than applied on a trial-and-error basis. For suitable cases, focused shockwave therapy is used because it can deliver energy accurately and deeply into the affected portion of the tendon, helping to stimulate the body’s natural healing response. This is combined with:
- A structured clinical assessment
- Supervised rehabilitation sessions
- A clear, progressive exercise plan to address contributing factors
This integrated approach is designed to be effective, efficient, and evidence-informed, supporting recovery while reducing the need for unnecessary appointments.
What to do next
If Achilles pain is affecting your daily life, the most important first step is a proper assessment.
Book a new patient consultation (£65) and we will assess your symptoms, confirm the diagnosis, and explain your options clearly - whether that's shockwave, rehabilitation, diagnostic ultrasound, or a combination. If shockwave is right for you, we will talk you through the package options at that appointment. Most people leave their first appointment knowing what's going on for the first time.
View our pricing and packages: tenbychiropractic.co.uk/pricing-and-cancellations
Related Pages
Focused Shockwave Therapy | Ankle & Foot Ultrasound Scan | Tendon Pain & Injuries | Plantar fasciopathy (under-heel pain)
