Achilles tendinopathy
- Annie Henderson, Triage Physiotherapist at Bupa
- Victoria Goldman, Freelance Health Editor
Key points
- Achilles tendinopathy is an injury to the Achilles tendon, which connects your calf muscle to your heel bone.
- It’s caused by overuse and repeated stress on the tendon.
- Symptoms of Achilles tendinopathy include pain, stiffness, and swelling around the tendon and your heel.
- Achilles tendinopathy is common, especially if you’re very active.
What is Achilles tendinopathy?
Achilles tendinopathy is an injury to the band of tissue (tendon) that connects the muscles in your lower leg to your heel bone. The Achilles tendon helps you to move your foot – when you walk, run, climb, or jump. It’s a common injury, especially if you’re very active.
Achilles tendinopathy is sometimes called Achilles tendonitis. But doctors don’t usually use this term anymore. Tendonitis means your tendon is inflamed. But because there isn’t always inflammation when your tendon is injured, this term isn’t strictly accurate.
Achilles tendinopathy symptoms
Achilles tendinopathy can cause several symptoms, including:
- pain in your heel
- stiffness in your tendon
- swelling at the back of your ankle
- tenderness when you touch your tendon
- a grating noise or creaking feeling (crepitus) when you move your ankle
Self-help for Achilles tendinopathy
You can try the following self-help measures to ease the symptoms of Achilles tendinopathy, without needing to see a health professional.
- Rest your tendon by reducing (or stopping) the activity that triggered your symptoms.
- Apply cold packs or ice wrapped in a towel to ease your pain and reduce any swelling. You can do this for 20 to 30 minutes every two to three hours.
- Take over-the-counter painkillers such as paracetamol to help ease the pain. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may also help to ease the pain. Always read the patient information leaflet that comes with your medicines.
Try to carry on putting weight on your leg if you’re able to. Gentle calf stretches may help. Or you could try exercises that don’t put too much stress on your Achilles tendon, such as swimming.
You can gradually restart your normal activities once the pain starts to ease. But avoid uphill and downhill running until the pain has completely gone and run on softer surfaces. Make sure you warm up well and do plenty of calf stretches and massage. You might find heel lifts helpful. These are insoles that you fit into each of your shoes.
Diagnosis of Achilles tendinopathy
If your symptoms don’t improve after a week of self-help measures, you may find it helpful to see a physiotherapist, podiatrist, or GP. A podiatrist is a specialist in conditions affecting the feet.
Your GP or physiotherapist will ask you about your symptoms and examine your leg, heel, and ankle. They may also:
- ask you about your medical history to check for other related causes or conditions
- check if any medicines you’re taking may have increased your risk of Achilles tendinopathy
Achilles tendinopathy can usually be diagnosed from your symptoms. So, you won’t usually need any further tests or scans. But sometimes your GP or physiotherapist may suggest a referral for an MRI or ultrasound if:
- your symptoms are severe
- they suspect an Achilles tendon rupture
- you’re not responding to treatment
Physiotherapy services
Our evidence-based physiotherapy services are designed to address a wide range of musculoskeletal conditions, promote recovery, and enhance overall quality of life. Our physiotherapists are specialised in treating orthopaedic, rheumatological, musculoskeletal conditions and sports-related injury by using tools including education and advice, pain management strategies, exercise therapy and manual therapy techniques.
To book or to make an enquiry, call us on 0330 127 7805
Achilles tendinopathy treatment
If self-help measures aren’t helping your Achilles tendinopathy, your GP or physiotherapist may suggest some treatments. This will usually involve a physiotherapy exercise programme to start with, before moving onto other treatments if this doesn’t work.
How long does it take Achilles tendinopathy to heal?
It can take weeks or even months to recover completely from Achilles tendinopathy. Most people find their symptoms get better after around 12 weeks of self-help measures and exercises. But other people may need more specialist treatments.
Physiotherapy exercises for Achilles tendinopathy
Physiotherapy can help to build up the strength and function in your Achilles tendon.
Your physiotherapist will suggest some exercises for you to do. They usually involve stretching and lengthening your Achilles tendon and surrounding muscles. To get the best results you’ll usually need to do Achilles tendinopathy exercises two to three times a day, on most days for at least three months.
Other treatments for Achilles tendinopathy
If your Achilles tendinopathy doesn’t improve with self-help measures or physiotherapy exercises, there may be other treatments you can try. These include the following.
- Extracorporeal shockwave therapy. This is where a machine passes shockwaves through your skin to the damaged part of your tendon to help ease your pain.
- Blood or platelet-rich plasma (PRP) injections. Your doctor injects your plasma or blood into, or around, your damaged tendon to help it heal faster.
- Dry needling. This involves passing a thin needle into your tendon to trigger the healing process and strengthen the tendon.
Achilles tendinopathy surgery
Most people don’t need surgery for Achilles tendinopathy. But if you’ve been trying other treatments for several months and they haven’t helped, surgery may be an option. Surgery involves removing damaged areas of your tendon and repairing what’s left of it. It takes time to recover from Achilles tendon surgery, and it doesn’t work for everyone with Achilles tendinopathy.
Causes of Achilles tendinopathy
Achilles tendinopathy is usually caused by overuse –repeated stress on your Achilles tendon over time. Any sports or activities that put stress on your Achilles tendon can lead to Achilles tendinopathy. This includes:
- running
- jumping
- cycling
You may also be more likely to damage your Achilles tendon if you:
- use badly designed equipment or wear the wrong footwear
- have a poor technique or haven’t trained properly for the activity you’re doing
- suddenly increase how much exercise you do or increase the intensity of your exercise
- train on hard or sloping surfaces
Other things that can make you more likely to develop Achilles tendinopathy include:
- getting older
- having a family history of the condition
- if you’ve injured your tendon or the muscles around it in the past
- having certain long-term health conditions such as rheumatoid arthritis, diabetes, high cholesterol or thyroid problems
- being very overweight or obese
- doing too much or too little exercise
- taking certain medicines such as corticosteroids, statins or antibiotics belonging to the quinolone group
What aggravates Achilles tendinopathy?
Certain things may make your Achilles tendinopathy worse. This includes any activity, footwear or equipment that puts pressure on your Achilles tendon. These activities usually involve running and jumping.
Prevention of Achilles tendinopathy
- There are several things you can do to help prevent Achilles tendinopathy. Make sure you wear appropriate and well-fitting shoes for running and other activities you do.
- Whether you’re active through work or sports, make sure you use the right equipment and techniques.
- Gradually build up new activities slowly. You should increase the intensity and duration of your activities slowly over time.
- Warm up well before you start exercising and stretch your calf muscles afterwards.
- If you have underlying health problems that put you at risk, make sure they’re being treated properly.
Aim to maintain a healthy weight because being overweight can increase your risk of Achilles tendinopathy. Wearing orthotics (special inserts) in each shoe may help if there’s a problem with the shape of your foot or how you walk.
Looking for fast access to quality care?
If you’re suffering from a muscle, bone or joint injury, as long as your symptoms are covered under your policy you can call us for advice and we can often authorise a consultation without the need for a GP referral.
To get a quote or to make an enquiry, call us on 0808 273 6216∧
Achilles tendon rupture
An Achilles tendon rupture is when you tear the tissue that connects your calf muscle to your heel bone.
Physiotherapy
Over-the-counter painkillers
Did our Achilles tendinopathy information help you?
We’d love to hear what you think.∧ Our short survey takes just a few minutes to complete and helps us to keep improving our health information.
∧The health information on this page is intended for informational purposes only. We do not endorse any commercial products, or include Bupa's fees for treatments and/or services. For more information about prices visit: www.bupa.co.uk/health/payg
This information was published by Bupa's Health Content Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals and deemed accurate on the date of review. Photos are only for illustrative purposes and do not reflect every presentation of a condition.
Any information about a treatment or procedure is generic, and does not necessarily describe that treatment or procedure as delivered by Bupa or its associated providers.
The information contained on this page and in any third party websites referred to on this page is not intended nor implied to be a substitute for professional medical advice nor is it intended to be for medical diagnosis or treatment. Third party websites are not owned or controlled by Bupa and any individual may be able to access and post messages on them. Bupa is not responsible for the content or availability of these third party websites. We do not accept advertising on this page.
- Achilles tendinopathy and rupture. Patient. patient.info, last updated March 2022
- Tendinopathy. BMJ Best Practice. bestpractice.bmj.com, last reviewed May 2024
- Tarantino D, Mottola R, Resta G, et al. Achilles tendinopathy pathogenesis and management: A narrative review. Int J Environ Res Public Health 2023; 20(17):6681. doi: 10.3390/ijerph20176681
- Achilles tendon injuries. Medscape. emedicine.medscape.com, updated September 2022
- Achilles tendon. Britannica. www.britannica.com, accessed June 2024
- Achilles tendinopathy. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2020
- Malliaras P. Physiotherapy management of Achilles tendinopathy. J Physiother 2022; 68(4):221–37. doi: 10.1016/j.jphys.2022.09.010
- Achilles tendinitis. MSD Manuals. msdmanuals.com, reviewed/revised November 2023
- Achilles tendon pain. British Orthopaedic Foot and Ankle Society (BOFAS). www.bofas.org.uk, accessed June 2024
- Achilles tendinopathy. Versus Arthritis. www.versusarthritis.org, accessed June 2024
- Heel pain. Royal College of Podiatry. rcpod.org.uk, accessed June 2024
- Find a chartered physiotherapist. Chartered Society of Physiotherapy. www.csp.org.uk, last reviewed January 2023
- Extracorporeal shockwave therapy for Achilles tendinopathy. The procedure. Interventional Procedures Guidance IPG571. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published December 2016
- Autologous blood injection for tendinopathy. The procedure. Interventional Procedures Guidance IPG438. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published January 2013
- Stoychev V, Finestone AS, Kalichman L. Dry needling as a treatment modality for tendinopathy: a narrative review. Curr Rev Musculoskelet Med 2020; 13(1):133–40. doi:10.1007/s12178-020-09608-0
- Personal communication from Annie Henderson, Bupa Triage Physiotherapist, July 2024
