Achilles Tendinopathy
Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026
Achilles tendinopathy is pain in the Achilles tendon, the thick cord that joins your calf muscles to your heel bone. It is common: about 4 to 7 per cent of people get the midportion type, and about 9 per cent of sporting people and 6 per cent of non-sporting people have it at some point. The main symptoms are pain, stiffness and swelling, often worst first thing in the morning or after rest. Most people improve with a steady, guided calf exercise programme, though it usually takes months rather than weeks.
What is it?
The Achilles tendon is the thick cord at the back of your ankle. It joins your calf muscles to your heel bone and helps you push off when you walk, run and jump. Achilles tendinopathy happens when this tendon becomes painful. It often brings swelling, stiffness and reduced function (it doesn't work as well as it should).
You may hear it called tendinitis or tendonitis. "Tendinopathy" is now the preferred name, because "tendinitis" suggests inflammation, and inflammation may not be present in the damaged tendon.
It is described by where it sits. Midportion tendinopathy is in the body of the tendon, about 2 to 6 cm above the heel bone. Insertional tendinopathy is where the tendon meets the heel bone. The midportion is affected in about 75 per cent of cases, and the spot where the tendon meets the heel bone in about 25 per cent.
Who does it affect?
It is common. About 4 to 7 per cent of people get the midportion type. Another way of counting suggests about 9 per cent of sporting people and 6 per cent of non-sporting people have it at some point in their lives. The figures differ because the groups of people counted were different, so treat them as a rough guide.
Midportion tendinopathy is more common in active people, especially those who run or jump. Insertional tendinopathy is more common in older people, and in people who are less athletic or carrying extra weight.
Signs and symptoms
The typical symptom is an aching pain in the tendon or at the back of the heel. It is often worst with your first steps in the morning, or when you start moving after sitting or resting. It usually eases as you keep moving, and the stiffness at the back of the ankle often settles after a few minutes of walking.
You may also notice tenderness when you press on the tendon, swelling, and sometimes a painful lump. Some people feel weaker when they push up onto their tiptoes. If the problem has been there a long time, pain can linger even after small amounts of activity.
What causes it?
The exact cause isn't fully understood. It seems to happen when the tendon can't keep up with the load placed on it. Small amounts of damage then build up within the tendon fibres. Overuse, or a sudden change in load, is strongly linked to it. Muscle weakness may also play a part.
Things that can raise your risk include:
- training mistakes, such as a sudden jump in exercise, intense interval training, more uphill or downhill work, or running on hard or sloping surfaces
- running and jumping sports
- very high or very low foot arches
- your footwear
- being overweight
- diabetes or high cholesterol
- inflammatory conditions and hormonal changes
- some medicines, including statins, corticosteroids and fluoroquinolone antibiotics
The sources don't show which of these matters most, so it isn't possible to rank them.
How is it diagnosed?
Your podiatrist diagnoses it from your story and an examination. They will ask when the pain happens, what eases it, and about your activity, footwear and general health. They will feel along the tendon and may test how well your calf works.
Tests can include heel raises, calf and hip strength, how far you can hop, and how far your ankle bends. These are easy to measure and help show where you are starting from. You may also be given a short questionnaire called the VISA-A, which scores how much the tendon affects you. Repeating it later helps you and your podiatrist track change.
An ultrasound can show changes in the tendon. How those changes relate to your pain and how well you move isn't clear.
Your podiatrist will also think about other causes of heel and calf pain. These include a partial tear, bursitis (an irritated fluid-filled cushion near the tendon), a nearby tendon causing pain, and in young people Sever's disease. Some conditions need a doctor's attention as well, such as inflammatory joint disease, high cholesterol that runs in families, hormonal conditions and drug reactions.
Treatment
Exercise is the main treatment, and most people improve without surgery.
Looking after it at home
Resting completely, or waiting to see what happens, isn't well supported. Gradually loading the tendon works better, and some improvement can show from about 2 weeks. A lower amount of exercise that you do as you can tolerate it has worked as well as, or better than, a higher amount.
Avoid big jumps in running, jumping or hill work. If your tendon is painful, ask your podiatrist how much activity suits you right now.
Treatment from your podiatrist
Your podiatrist will usually give you a progressive calf-loading programme. Two kinds are supported. Eccentric exercises are slow, controlled calf work that focuses on the lowering part of the movement. Heavy slow resistance is heavy, slow strengthening. A well-known eccentric programme runs for 12 weeks. It helps in almost 90 per cent of midportion cases, but only about 30 per cent of insertional cases show promising results. In exercise programmes built around eccentric calf training, 82 per cent of people had recovered at 3 months.
Give exercise at least 3 months before other options are considered. Your podiatrist will usually build up your load according to what your calf can handle, rather than by pushing through pain or sticking to a fixed timetable. Insertional tendinopathy often needs modified exercises, so get your programme guided by a clinician.
Other options
If you haven't improved after 3 months of exercise, or your tendon problem is severe, your podiatrist may refer you to a musculoskeletal expert, such as a sport and exercise medicine physician. They can arrange further tests, such as an ultrasound or MRI, and add-on treatments.
Platelet-rich plasma (PRP) injections and shockwave therapy (pulses of sound waves aimed at the tendon) are options if exercise alone hasn't given enough relief. Shockwave works is contested, and tendon ruptures have been reported after it, so ask about the benefits and risks first. Dry needling is another option sometimes used after exercise has been tried.
Corticosteroid (cortisone) injections are generally avoided. They have been linked to the tendon rupturing, especially when injected into the tendon, and they don't help in the long term.
Surgery
Surgery is a last resort and may not fully clear your symptoms. It is generally considered only after at least 3 to 6 months of well-delivered non-surgical care.
Recovery
The outlook is good, but it takes patience. About 75 per cent of people improve during 3 to 6 months of non-surgical care. Expect months rather than weeks, and keep up your exercise programme for at least 3 months.
Scans don't predict how well you will recover, and they aren't needed to track your progress. Your podiatrist can use your heel-raise ability, your calf strength and the VISA-A questionnaire instead. Talk to your podiatrist about how to return to running or sport step by step.
Preventing it
The main step is to build up running, jumping and hill training gradually rather than suddenly. If you have risk factors such as diabetes, high cholesterol or an inflammatory joint condition, mention them to your podiatrist or GP.
How long to keep doing calf exercises after you recover isn't clear yet, so ask your podiatrist what suits you.
When to see a podiatrist
Book an appointment if
You have pain at the back of your heel or lower calf that is worst first thing in the morning or after rest, and you'd like a proper diagnosis. Also book if it hasn't improved after about 3 months of regular calf exercises, or if it is severe or stops you doing your usual activities. Your podiatrist can then talk to you about referral to a musculoskeletal expert.
Seek prompt assessment if
See your GP or another doctor today if you feel a sudden snap or pop, or a sudden feeling of being kicked in the calf, with sudden severe pain, or you can't push off, point your foot down, go up on your tiptoes or do a single-leg heel raise. The Achilles tendon may have torn. Don't wait to see whether it settles, and don't be reassured if you can't feel a gap in the tendon, because a tear can still be there. This also applies if it happens during or after treatment such as shockwave. If your GP can't see you today, go to an urgent care clinic or an after-hours GP.
See your GP soon if tendon pain starts while you are taking a medicine such as a fluoroquinolone antibiotic or a corticosteroid, or after a steroid injection. Don't stop a prescribed medicine on your own: tell your prescriber or GP promptly. See your podiatrist or GP soon if you have heel pain together with pain and swelling in other joints, or if your symptoms change unexpectedly or don't behave as expected.
Frequently asked questions
Do I need a scan?
Not usually. Your podiatrist can diagnose Achilles tendinopathy from your story and an examination. Scans don't predict how well you will recover or help track progress. Your specialist may arrange an ultrasound or MRI if you haven't improved with exercise or your problem is severe.
Could strengthening exercises make my tendon snap?
No. Rupture is uncommon in tendinopathy, about 4 per cent of people, and slightly more likely over age 50. Doing strengthening exercises does not increase that risk. Rupture is a risk worth knowing about, but it isn't a reason to avoid your exercises.
What is the difference between tendinopathy and tendinitis?
Tendinopathy is the preferred name for a painful tendon. Tendinitis suggests the tendon is inflamed, but inflammation may not be present. That is why treatment focuses on gradually loading the tendon with exercise, not on calming inflammation.