Achilles tendinopathy causes pain and stiffness in the Achilles tendon, characteristically worst after rest and with activity start-up. Progressive exercise loading is the most effective treatment. Rest alone makes it worse. Recovery takes 8–16 weeks for mild cases, up to 12 months for chronic presentations.
Achilles tendinopathy is one of the most common overuse injuries in active people, affecting 4 to 7% of the general population and up to 43% of elite athletes. It causes pain and stiffness in the Achilles tendon, typically after periods of rest and during or after exercise. A structured, progressive exercise programme is the most effective treatment and is the starting point for most people regardless of severity.
The Achilles tendon is the strongest and largest tendon in the body. It connects your calf muscles (gastrocnemius and soleus) to your heel bone (calcaneus) and is essential for walking, running, and jumping. Achilles tendinopathy occurs when the tendon becomes painful and its normal tissue structure is disrupted, usually as a result of repetitive overloading.
The term "tendinopathy" is preferred to older terms like "tendinitis" (which implies acute inflammation) or "tendinosis" (which implies degeneration), because the actual tissue changes are more complex and this distinction helps guide treatment.
There are two main types:
Achilles tendinopathy is particularly common in:
It is more common in men than women, and obesity, diabetes, and certain medications (particularly fluoroquinolone antibiotics) are known risk factors.
The characteristic pattern of Achilles tendinopathy is:
If you feel or hear a sudden snap or pop in the back of your leg during activity, and cannot stand on tiptoe or walk normally, stop all activity and seek urgent assessment. This may indicate a tendon rupture, which requires prompt treatment.
Your podiatrist will diagnose Achilles tendinopathy through:
Ultrasound imaging is often used to confirm the diagnosis, measure tendon thickness, and rule out a partial tear. MRI provides more detail if the diagnosis is uncertain or a tear is suspected.
Treatment of Achilles tendinopathy centres on progressive tendon loading — gradually increasing the demands on the tendon to stimulate tissue adaptation and recovery. This is quite different from simply resting, which tends to weaken the tendon further.
First-line treatment — exercise rehabilitation:
A structured exercise programme is the most evidence-based treatment for Achilles tendinopathy. Your podiatrist or physiotherapist will design a programme tailored to your stage of recovery. This typically includes:
The programme progresses over 12 to 16 weeks. It is normal to experience some discomfort during exercise, but pain levels should not significantly increase, and any post-exercise soreness should settle within 24 hours.
Adjunct treatments:
Second-line treatments (if exercise alone is insufficient after 3 months):
Third-line (for chronic, refractory cases):
What does NOT work:
See a podiatrist promptly if:
Recovery from Achilles tendinopathy takes longer than most people expect:
The key message is that consistency with loading exercises, even when the tendon is sore, produces better outcomes than repeated periods of rest. Progress should be monitored using a validated tool (VISA-A) and loading adjusted accordingly.
Mild cases improve in 8 to 12 weeks with consistent exercise rehabilitation. Chronic cases can take 6 to 12 months. The biggest factor in recovery time is how consistently the prescribed loading programme is followed.
Not necessarily. Complete rest is not recommended as the tendon needs graduated loading to recover. Your podiatrist can advise on modifying rather than stopping activity — switching to lower-impact exercise while continuing rehabilitation.
Cortisone injections are not recommended for Achilles tendinopathy. While they may provide short-term pain relief, they are associated with tendon weakening and increased risk of tendon rupture.
The Victorian Institute of Sport Assessment — Achilles (VISA-A) is a validated questionnaire that measures symptom severity and function in Achilles tendinopathy. It is used to track progress over time and guide loading decisions during rehabilitation.
A rupture typically involves a sudden sharp pain and a feeling or sound like a snap or pop at the back of the leg. You will usually be unable to stand on tiptoe or walk normally. This requires urgent medical assessment.