Does it ease as you get moving, only to return after walking, running or exercise?
Achilles tendinopathy is a common cause of persistent pain and stiffness around the Achilles tendon. It can affect everyday walking as well as running, sport and other activities, but most cases can be managed effectively with appropriate load management and progressive rehabilitation.
The Achilles tendon is the strong tendon connecting the calf muscles to the heel bone. It plays an important role in walking, running and jumping by transmitting force from the calf and helping propel the body forwards.
Achilles tendinopathy is a load-related condition in which the tendon becomes painful and less able to tolerate the demands placed upon it.
Symptoms often develop gradually rather than following a single injury. Simply resting the tendon may reduce symptoms temporarily, but rehabilitation usually focuses on gradually rebuilding its strength and capacity to tolerate everyday activity and exercise.
Achilles tendinopathy commonly causes:
Symptoms can affect one or both Achilles tendons.
Achilles tendinopathy can affect people of all activity levels.
It is particularly common in runners and recreational athletes, but it can also occur in people who spend long periods walking or standing, have recently increased their activity, or return to exercise after a period of reduced activity.
Symptoms often develop gradually and may occur without any single obvious injury.
The location of the pain is important because different parts of the Achilles tendon can behave differently and may require different rehabilitation strategies.
Mid-portion Achilles tendinopathy
Mid-portion Achilles tendinopathy affects the tendon approximately 2-6 cm above the heel bone.
Typical features include:
Progressive strengthening and tendon-loading exercises form the mainstay of rehabilitation.
Focused shockwave therapy may also be considered in some persistent cases.
Insertional Achilles tendinopathy
Insertional Achilles tendinopathy affects the lower end of the tendon where it attaches to the heel bone.
Typical features include:
Insertional symptoms can be particularly sensitive to compression, so rehabilitation may need to be adapted accordingly.
Rehabilitation is usually the foundation of treatment.
The aim is to gradually improve the ability of the Achilles tendon and calf muscles to tolerate the loads required for everyday activity, work, exercise or sport.
Management may include:
Complete rest is rarely the long-term solution. The goal is normally to find a level of activity the tendon can tolerate and progressively build from there.
At Tenby Health, treatment starts with establishing what is actually causing your symptoms.
Achilles pain is not always caused by Achilles tendinopathy. Pain around the back of the ankle and heel can arise from several different structures, which is why your assessment considers the location and behaviour of your symptoms alongside tendon function, calf strength, movement and the activities that provoke your pain.
Where it is likely to add useful information, we can also perform diagnostic musculoskeletal ultrasound. Ultrasound allows us to examine the Achilles tendon directly and assess for features such as tendon thickening, structural change, partial tearing, calcification and other ultrasound-detectable causes of pain around the back of the ankle and heel.
Importantly, not everyone with Achilles pain needs a scan. We recommend imaging when it is likely to help clarify the diagnosis or influence how your problem is managed.
Treatment can then be tailored to what we find and may include:
Our aim is to give you a clear explanation of the problem and a practical plan for improving it, without unnecessary treatment or appointments.
If Achilles pain is limiting your walking, exercise or sport, the first step is a clinical assessment.
Book a new patient consultation. We will assess your symptoms, establish the most likely diagnosis and explain your options clearly.
Depending on what we find, this may involve rehabilitation, focused shockwave therapy, diagnostic ultrasound or a combination where appropriate.