Achilles tendinopathy

Published by Bupa’s Health Information Team, December 2011.

This factsheet is for people who have Achilles tendinopathy, or who would like information about it.

Achilles tendinopathy is when the Achilles tendon becomes injured, causing pain and sometimes swelling in the lower leg. The Achilles tendon is a strong band of fibres that connects two calf muscles in the leg to the heel bone.

About Achilles tendinopathy

Your Achilles tendon is made up of many fibres of collagen, which make it very strong. It connects the two muscles in your lower leg (calf) to the bone in the heel of your foot.

Your Achilles tendon is the largest tendon in your body. It allows you to run, walk, jump and go up and down stairs. Achilles tendinopathy is an injury to your Achilles tendon. It usually happens over a period of time when your tendon has been overused. It’s a condition that mostly affects people who play sport, particularly runners. It’s more common in men than women and often affects men between the age of 30 and 40.

Symptoms of Achilles tendinopathy

 The main symptom of Achilles tendinopathy is pain, usually at the bottom of your calf. You may also have some stiffness. The pain from Achilles tendinopathy is usually worse first thing in the morning and may interfere with your day-to-day life.

At first you may find that you have pain when you start and finish exercise, but the pain goes away during exercise. Over time, as the injury gets worse, you may also have pain during exercise and it may become constant. You may also have some swelling and your Achilles tendon might feel tender when you touch it.

If you get a sudden pain in your heel or calf, and your heel becomes swollen bruised and painful, you may have completely torn your Achilles tendon. If this happens, you must seek urgent medical attention.

Causes of Achilles tendinopathy

Achilles tendinopathy is a common injury in runners and people who play sports that involve running. 

It’s usually caused by overuse of the Achilles tendon. As you get older your Achilles tendon becomes less flexible and less able to cope with the stress that running puts on it. In some cases, very small tears start to develop and if you carry on running, the tears don’t heal and the tendon becomes weaker. Achilles tendinopathy is more likely to develop if you:

• increase how far and how fast you run too quickly
• start exercising too quickly after a period of not exercising
• add stair climbing or running uphill to your exercise routine
• change the surface you run on, for example from grass to road
• change the shoes you wear, or wear the wrong type of shoes
• have weak calf muscles
• roll your feet inwards as you run (overpronation)
• wear high heels

Diagnosis of Achilles tendinopathy

Your GP or physiotherapist will ask you about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP or physiotherapist may examine your lower legs and ask you to do some exercises to test how well your tendon is working. This may include hopping or putting weight onto the ball (front) of your foot while raising your heel off the floor.

These tests are usually enough for your GP or physiotherapist to diagnose Achilles tendinopathy. However, a few people may need other tests. The main ones are listed below.

• An ultrasound scan. This uses sound waves to produce an image of the inside of your Achilles tendon.
• An MRI scan. This uses magnets and radiowaves to produce images of the inside of your Achilles tendon.

Treatment of Achilles tendinopathy

The type of treatment you may need will depend on how serious your injury is. The symptoms of Achilles tendinopathy can take between three and six months to get better (see our common questions for more information). 

Self-help

There are a number of things you can do to help Achilles tendinopathy. The main ones are listed below.

• Reduce the amount of exercise you’re doing and how often you exercise. This will help to rest your tendon.
• Wear a small heel raise in each shoe. This helps to reduce the stress on your Achilles tendon.
• Wear well padded and supportive shoes.
• Run or exercise on a soft running surface.
• Stretch your Achilles tendon every day. Your GP or physiotherapist will show you how to do these.

If the pain or swelling is bad, you can ice the injured area using an ice pack or ice wrapped in a towel to reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.

Medicines

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Physical therapies

Your GP may refer you to a physiotherapist, a health professional who specialises in maintaining and improving movement and mobility. You can also choose to see a private physiotherapist.

The treatment will aim to strengthen and stretch your Achilles tendon. Your physiotherapist will give you a programme that will include stretching exercises. You will need to do these exercises daily for a minimum of one month to get the most from your treatment.

Your physiotherapist may use other techniques to help reduce your pain and speed up the healing of your Achilles tendon, such as massage and acupuncture.

If your Achilles tendinopathy doesn’t get better with other treatments, your GP or physiotherapist may refer you to a doctor who may suggest extracorporeal shockwave therapy. It’s a relatively new treatment and doctors still don’t know how well it works. This is where high energy shockwaves are passed through your skin to the affected area of your tendon using a special machine. Talk to your doctor for more information about this treatment.

Surgery

Your doctor may recommend surgery if other treatments don’t work and if your symptoms are having an impact on your day-to-day life.

Surgery involves removing damaged areas of tendon and then repairing them.

Prevention of Achilles tendinopathy

There are a number of things you can do that may help to prevent Achilles tendinopathy. The main ones are listed below. 

• Choose running shoes that have a cushioned heel and are suited to your foot type.
• Walk and stretch to warm up your calf muscles before you start running or playing sport.
• When you start running, gradually increase the amount you do and the speed that you run at, but don’t do both at the same time.
• Don’t sprint or do hill running if you’re not used to it.
• Cool down properly after exercise.
• If the shape of your foot increases the stress on your Achilles tendon, wear a custom-made moulded insole in your shoe. Ask your GP or physiotherapist about these.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.