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Achilles tendinopathy

Achilles tendinopathy is pain in the tendon at the back of your heel or lower calf, often worst first thing in the morning or after rest. It usually builds up from overload. Gradual calf-strengthening exercise is the first treatment, and most people improve over a few months.

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPodLast reviewed 27 October 2026 6 min read

Jump to a section
  1. 1. What is Achilles tendinopathy, and how common is it?
  2. 2. What causes it, and who gets it?
  3. 3. What does it feel like, and how is it diagnosed?
  4. 4. What helps first?
  5. 5. What helps if exercise isn't enough?
  6. 6. How long does it take, and can it come back?
  7. 7. When to see a podiatrist

At a glance

  • It's pain in the Achilles tendon, at the back of the heel or lower calf, often worst first thing in the morning or after rest.
  • It usually builds up from overload, such as a sudden jump in running, jumping or hill training.
  • Gradual calf exercises are the first treatment, and they're worth trying for at least 3 months.
  • Rest alone isn't the answer: keeping the tendon gently loaded helps more than waiting.
  • A sudden snap or pop is different and needs to be checked the same day.

What is Achilles tendinopathy, and how common is it?

Achilles tendinopathy is pain in the Achilles tendon, the thick cord at the back of your ankle that joins your calf muscle to your heel bone. It often brings swelling and stiffness, and is usually worst first thing in the morning or after rest. You may also hear it called Achilles tendinitis or tendonitis, but tendinopathy is the preferred name, because inflammation may not be present in the damaged tendon.

It's common: about 9% of people who play sport and 6% of those who don't develop it at some point. It most often affects the middle of the tendon (midportion), and less often the spot where the tendon meets the heel bone (insertional).

What causes it, and who gets it?

The exact cause isn't fully understood. It seems to happen when the tendon can't keep up with the load on it, so small amounts of damage build up in the tendon fibres. There's a strong link with overuse or a sudden change in load, such as a quick increase in exercise or activity, and running and jumping sports add to the risk.

Anyone can get it. The midportion type is more common in active people, while the insertional type is more common in older people and those who are less athletic or overweight. Other things linked with it include very high or low foot arches, footwear, diabetes, high cholesterol, inflammatory conditions, and some medicines, such as statins, corticosteroids and fluoroquinolone antibiotics. If you have several of these, mention them to your clinician. Building up running, jumping or hill training gradually is a sensible habit.

What does it feel like, and how is it diagnosed?

It typically feels like an aching pain around the tendon or heel, worse with activity or pressure. You may have stiffness first thing in the morning or after rest that eases as you keep moving. There can also be tenderness, swelling, sometimes a painful lump, and less strength when you push up onto your toes.

A podiatrist, physiotherapist or GP can usually diagnose it from your story and an examination, with strength tests such as repeated heel raises. Scans aren't needed to predict how you'll recover. Other problems can feel similar, such as a partial tear, pinching at the back of the ankle or trouble with a nearby tendon, which is why a proper assessment matters.

What helps first?

Exercise is the first treatment. Gradually increasing the load through the tendon over time is the most effective approach. Both eccentric calf exercises (slowly lowering your heel) and heavy slow resistance (slow, heavy calf work) are supported. Loading works better than rest or waiting it out, with improvement seen from as early as 2 weeks, and a 'do as tolerated' approach did as well as or better than a harder one.

Try exercise for at least 3 months before moving to other options. A podiatrist or physiotherapist can set up a programme for you. The insertional type tends to respond less well and often needs modified exercises. Strengthening exercises don't raise your risk of tearing the tendon. Cortisone injections aren't a first-line choice.

What helps if exercise isn't enough?

If you've had 3 months of regular exercise without improvement, or your symptoms are severe, ask for a referral to a musculoskeletal expert, such as a sport and exercise medicine physician. They can arrange further tests and add-on treatments. Platelet-rich plasma (PRP) injections and shockwave therapy can be considered as second-line options, and surgery is a last resort that may not fully resolve symptoms. Which add-on works best isn't clear yet, so ask about the benefits and risks before agreeing. Tendon ruptures have been reported after focused shockwave therapy.

Corticosteroid (cortisone) injections, especially into the tendon, are linked with rupture and are generally avoided. They also aren't effective in the long term.

How long does it take, and can it come back?

Expect months rather than weeks. Exercise-based care is usually continued for at least 3–6 months, and most people improve in that time. A short questionnaire (VISA-A) can track your progress, and scan findings don't predict your outlook.

How to stop it coming back isn't clear yet. Building up your activity gradually is a sensible step. Ask your podiatrist or physiotherapist how long to keep up your calf exercises and how to return to running or sport.

When to see a podiatrist

See your GP or a podiatrist the same day if you feel a sudden snap or pop, a sudden feeling of being kicked in the calf, or sudden severe pain at the back of the heel or calf, or if you can't push off, point your foot down or do a single-leg heel raise. These can mean the tendon has torn. Don't wait to see if it settles, and don't rely on feeling for a gap, as a torn tendon may not have one. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic.

See your GP if tendon pain starts while you're taking a medicine such as a fluoroquinolone antibiotic, or after a steroid injection. Don't stop a prescribed medicine on your own. See your GP too if you have swollen, painful joints elsewhere, or a cholesterol or hormone condition, as these can need attention alongside the tendon.

See a podiatrist or your GP if your pain isn't improving after 3 months of exercise, is severe, or changes unexpectedly.

Common questions

Is Achilles tendinopathy the same as Achilles tendinitis?

Mostly, yes: they describe the same painful tendon. Tendinopathy is now the preferred name because 'tendinitis' suggests inflammation, which may not be present in the damaged tendon. The treatment doesn't change with the name. Exercise-based care is the first step, rather than anti-inflammatory treatment.

What's the difference between insertional and midportion Achilles tendinopathy?

It's about where the tendon is sore. Insertional pain sits where the tendon joins the heel bone. Midportion pain sits a few centimetres higher up, in the body of the tendon. Midportion is the more common type. Because the two respond differently to exercise, a podiatrist can adjust your programme to suit.

Should I rest or keep exercising with Achilles tendon pain?

Complete rest on its own isn't well supported. It usually helps to keep the tendon gently loaded with calf exercises that a podiatrist or physiotherapist sets up for you, and to cut back on whatever clearly aggravates it, such as a sudden increase in hill running.

Further reading

Want to know more? Achilles tendinopathy on Clindice

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod

Podiatrist

Reviewed 27 October 2026. Next review by 27 October 2027.

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Sources

(12)
  1. 1.Achilles Pain / TendinopathyNHS
  2. 2.Current concept review of Achilles tendinopathyMoonot P, Dakhode S · Journal of Clinical Orthopaedics and Trauma · 2024
  3. 3.Achilles tendinopathy: a guide for general practiceOgbonmwan I, Kilcourse E, Gupta S · The British Journal of General Practice · 2020
  4. 4.A Patient's Guide to Achilles TendinopathyNHS · 2026
  5. 5.UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approachJudd A, Wild K, Puxley L et al. · BMJ Military Health · 2026
  6. 6.Achilles tendinopathy physical impairments evaluated through clinician-friendly measures: a systematic review with meta-analysis and GRADE recommendationsFerreira VML, Pinto RZ, Simoneau G et al. · Brazilian Journal of Physical Therapy · 2025
  7. 7.Dutch multidisciplinary guideline on Achilles tendinopathyde Vos RJ, van der Vlist AC, Zwerver J et al. · British Journal of Sports Medicine · 2021
  8. 8.Diagnostic domains, differential diagnosis and conditions requiring further medical attention that are considered important in the assessment for Achilles tendinopathy: a Delphi consensus studyMalliaras P, Silbernagel KG, de Vos RJ et al. · British Journal of Sports Medicine · 2025
  9. 9.A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and ImplementationGrävare Silbernagel K, Crossley KM · The Journal of Orthopaedic and Sports Physical Therapy · 2015
  10. 10.AchillesNHS
  11. 11.Shockwave Therapy for Midportion and Insertional Achilles Tendinopathy: A Nail in the Coffin? A Systematic Review With Meta-AnalysisKorakakis V, Kotsifaki R, Sotiralis Y et al. · The Journal of Orthopaedic and Sports Physical Therapy · 2026
  12. 12.Achilles tendon rupture | Right DecisionsNHS

This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.

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