Achilles Tendinopathy: Heel Pain Causes, Symptoms and Treatment

What is the Achilles tendon, and what does it do?

The Achilles is the thickest tendon in the body. It joins the calf muscles to the heel bone and stores energy every time you push off. Walking uses it, running loads it far more, and jumping more again. Because it carries the whole force of your push-off, it is easily irritated by a change in demand.

Why does Achilles tendon pain happen?

Two things usually meet. The tendon carries less than the load placed on it, and the load has recently gone up. Common triggers are a longer run, a new court session, a return to sport after months away, a change of shoes or surface, or hours on your feet at work.

Some things lower what the tendon tolerates. A weak calf, a stiff ankle and extra body weight count. Age between 30 and 60 raises the odds, and so do diabetes and some other long term conditions. Certain antibiotics and steroid tablets are linked to tendon trouble as well.

This sits inside a wider family of tendon overload problems. The general picture is on the tendinopathy page, and the principle holds wherever the tendon is.

What does Achilles tendinopathy feel like?

Three features point to it:

• The first steps in the morning are the worst, and the tendon eases as you warm up.
• The pain returns after exercise, sometimes the next morning rather than during the session.
• The tendon is tender to press and may feel thicker than the other side.

Pain on stairs, on hopping or on a single leg heel raise is typical. Where the pain sits also matters. Midportion pain is 2 to 6 cm above the heel, in the middle of the tendon. Insertional pain is right at the heel bone. That difference decides which exercises you can do, which is why the assessment looks at the site and not only at the name.

Pain under the foot rather than behind the heel points elsewhere, usually to plantar fasciitis.

Is it the same as a torn Achilles tendon?

No. A tendon made painful by overload is still continuous. A rupture is a complete tear and behaves differently. You often cannot push the foot down, cannot rise onto that heel, and may feel a gap in the tendon.

The squeeze test is the quick check. Lying face down, the clinician squeezes the calf from behind, and a working tendon pulls the foot. If the foot does not move, the tendon is not passing force through. That is why heel pain should be examined before you start loading it.

What does treatment involve?

Progressive loading is the core treatment, and it is exercise rather than a machine. The shape of it:

• Calf raises done slowly, with the heel dropping below the toes on a step for midportion problems.
• Slow heavy resistance, using weight or a single leg version that feels hard by the last few repetitions.
• A load that rises as the tendon settles, adjusted rather than abandoned in a sore week.

Insertional pain changes the exercise. Keep the heel flat on the ground and avoid dropping it off a step edge, because that position compresses the tendon against the bone and tends to aggravate it. A heel lift can help early on.

Shockwave therapy is used in selected cases, usually chronic midportion pain, and alongside loading rather than instead of it. Platelet-rich plasma is used in selected cases too. The evidence is mixed and does not show a consistent advantage over a placebo injection, so it is discussed case by case and response varies.

Steroid injections around the tendon are avoided. They can settle pain briefly but weaken the tendon, and repeated injections carry a risk of rupture. Surgery is reserved for those who do not settle after several months of structured care.

The same loading principle applies at the front of the knee, to jumper’s knee.

Why is complete rest not the answer?

Complete rest removes the load that keeps a tendon strong, and tendons lose capacity quickly when unloaded. Pain often settles while you do nothing and returns as soon as you go back to your old volume. Better is to cut load to a level the tendon can cope with, keep the training it tolerates, and build back up. That is why the plan is a modified programme rather than a stop sign.

How long does it take to recover?

Recovery is gradual and depends on how long the tendon has been sore, how much load you carry, and how consistently the exercises are done. There is no fixed timetable. The clinical literature describes full recovery often taking several months, commonly in the range of three to six months, with progress arriving in steps. Recurrence is possible if load management is dropped, so judge progress by what you can do again rather than by the pain score on one day.

Where can I get my heel pain assessed?

Dr Harith Rosdi assesses Achilles and other heel pain at IIUM Sports Medicine Clinic (ISMEC) in Kuantan. The assessment covers where the pain sits, how the tendon behaves under load, and whether the calf, ankle or footwear is adding to it. Imaging is arranged when it would change the plan.

Frequently Asked Questions

Do I need a scan to confirm Achilles tendinopathy?

Not usually. The diagnosis comes from the story and the examination, and the site of the pain separates midportion from insertional disease. An ultrasound is arranged when the picture is unclear, when a tear is a concern, or when the result would change what is done next.

Can I keep training with Achilles pain?

Often yes, at a reduced level. The usual approach is to keep what you can do without a flare the next day, and to run the loading programme alongside it. Sports built on repeated jumping and hard push-off are usually cut back first. What you keep is decided at assessment.

Will the pain come back?

It can. Recurrence is described in the clinical literature when load management is dropped after the pain settles. Keeping the strengthening work in your week, and raising volume in steps rather than jumps, is what reduces that risk.

Related Articles

• Tendinopathy
• Plantar Fasciitis
• Jumper’s Knee