Achilles tendinopathy

Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
Next review due August 2022

Achilles tendinopathy is an injury to the band of tissue (tendon) that runs down the back of your lower leg to your heel. You may get pain, stiffness and sometimes swelling that makes it hard for you to move freely.

Image showing the Achilles tendon

About achilles tendinopathy

Achilles tendinopathy can make it hard to walk and may stop you carrying on as normal. It may be caused by a specific injury that damages your Achilles tendon or can be caused by repeated small amounts of damage through overuse.

Your Achilles tendon is the thickest and strongest tendon in your body. It connects your calf muscle to the bone in the heel of your foot. It helps move your foot when the muscles contract. Your Achilles tendon enables you to go on tiptoe or move forwards when you walk, run or climb.

You can get Achilles tendinopathy if you damage your Achilles tendon and it doesn’t heal properly. This damage can get gradually worse over time. Achilles tendinopathy can affect anyone, but especially people who do activities that involve running and jumping. Over 150,000 people are affected by Achilles tendinopathy every year.

Achilles tendinopathy symptoms

Achilles tendinopathy can cause several symptoms, including:

  • increasing pain, usually at the back of your leg or heel
  • stiffness in the tendon
  • swelling at the back of your ankle
  • tenderness when you touch the tendon
  • a grating noise or creaking feeling (crepitus) when you move your ankle

If you think you have Achilles tendinopathy, speak to your GP or a physiotherapist. You can book a private appointment directly with a physiotherapist, do a self-referral to an NHS physiotherapist or you may need to get a referral through your GP.

The pain of Achilles tendinopathy can come and go. It may be worse first thing in the morning or after you’ve done some exercise or activity. Your Achilles tendon may feel particularly stiff if you haven’t moved around for a while — perhaps sat at your desk or on the sofa. The stiffness may ease off when you start moving again.

Achilles tendinopathy can affect your day-to-day life. It may mean you need to take time off work, especially if you have an active job. You may not be able to do a lot of activity, including sports, until your tendon gets better.

Sudden pain in your heel or calf can mean you’ve torn the tendon. This is called an Achilles tendon rupture. Your tendon becomes swollen, bruised and sore, and you may even hear it snap. If this happens, seek urgent medical advice.

Diagnosis of achilles tendinopathy

Your GP or physiotherapist will ask you about your symptoms and examine your leg, heel and ankle. They may ask you to do a series of movements or exercises to help them see how well you can move your leg. They may squeeze your calf muscle to check the movement of your foot.

They may also ask you about your medical history and rule out other related causes or conditions.

Achilles tendinopathy can usually be diagnosed from your symptoms. But sometimes your GP may suggest that you have an ultrasound scan or MRI scan to see if there are tears in your Achilles tendon.

If you have an underlying condition, such as arthritis, diabetes or high cholesterol levels, you may be referred to a specialist doctor. If your symptoms are very bad, or have lasted for more than six weeks, you may be referred to an orthopaedic surgeon who specialises in foot and ankle surgery.

Self-help for achilles tendinopathy

There are a number of things you can do to ease the symptoms of Achilles tendinopathy. The most important one is to rest the tendon. Reduce (or stop) the activity that triggered your symptoms. If your pain eases, you may be able to do some gentle stretches. If you can, carry on putting weight on your leg by standing and doing some gentle walking. Avoid uphill and downhill running until the pain has gone.

Apply cold packs or ice wrapped in a towel to ease the pain and reduce any swelling. Don’t apply ice directly to your skin as it may damage it.

If your symptoms don’t ease after seven to 10 days, you may find it helpful to see a physiotherapist. You may be able to make an appointment yourself or your GP may need to refer you. See our Physiotherapy for Achilles tendinopathy section below.

An orthotic insole in each shoe that lifts your heel slightly may reduce the stress on your Achilles tendon. Wearing well-padded and supportive shoes may also help.

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Achilles tendinopathy treatment

If you think you’ve damaged your Achilles tendon, it’s important to seek medical advice straightaway from a physiotherapist or musculoskeletal (MSK) specialist. Achilles tendinopathy gets harder to treat the longer you leave it untreated. As soon as your symptoms start, it’s important to rest your damaged tendon and stop doing any activities that cause it or make it worse.

Your treatment will depend on how bad your Achilles tendinopathy is. Generally, your symptoms should improve after three months. For more information, see our FAQ: How long does Achilles tendinopathy last?

Medicines for Achilles tendinopathy

If you need pain relief, you can take over-the-counter painkillers, such as paracetamol. Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may also help to ease the pain at first, but you shouldn’t take them for very long.

Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

If you’re taking antibiotics and have Achilles tendinopathy, tell your GP. If you’re taking quinolone antibiotics, you’ll probably be recommended to stop taking these straightaway because they could make your tendinopathy worse.

Your GP or a pharmacist can tell you which medicines you’re taking if you’re unsure.

Physiotherapy for Achilles tendinopathy

If your symptoms aren’t any better after a week or so, you should book an appointment with a physiotherapist. You can either do this privately or via self-referral to an NHS physiotherapist. If you can’t self-refer in your area, ask your GP to refer you.

Physiotherapy can help to strengthen and stretch your Achilles tendon. You may need two to three physiotherapy sessions a week for about six weeks. It can take time to build up the eccentric exercises your physiotherapist gives you to do. You’ll probably be recommended to do the exercises every day for at least three months to get the best out of them.

Your physiotherapist may give you exercises to do twice a day. These may include ‘eccentric exercises’ that include heel-lowering movements, which help to reduce pain and speed up your recovery.

Non-surgical treatments for Achilles tendinopathy

If your condition isn’t any better after six weeks, this is called chronic Achilles tendinopathy. Your GP may refer you to a sports medicine specialist or orthopaedic doctor.

You may be recommended to try some other treatments. Some of these are relatively new and may only be available as part of a research programme. You’ll probably still have exercises to do as well.

Your physiotherapist or doctor may recommend any of the following if they’re available and suitable for you.

  • Extracorporeal shockwave therapy. A machine passes shockwaves through your skin to the damaged part of your tendon. You may need several sessions.
  • Blood or platelet-rich plasma (PRP) injections. These use part of your own blood that’s rich in growth factors and may help your Achilles tendon to heal faster. Ultrasound machines can guide the blood or plasma to where it’s most useful.
  • Low-level laser therapy. This may help to repair damage to your tendon.
  • Dry needling. This involves passing a thin needle into your tendon regularly to trigger the healing process and strengthen your tendon.

Surgery for Achilles tendinopathy

If your symptoms are very bad and other treatments haven’t helped after several months, your doctor may suggest surgery. Your GP can refer you to a specialist foot and ankle surgeon, who may want to do a scan to check the condition of your tendon.

If you have surgery, this may involve removing damaged areas of your tendon and repairing what’s left of it. The surgeon may need to use tissue from higher up your Achilles tendon, or from another one of your tendons, to do these repairs. Your wound may take time to heal and leave scars. Some people who have surgery don’t get back enough strength in their tendon to return to running and other sports.

Causes of achilles tendinopathy

Achilles tendinopathy is usually caused by overusing your Achilles tendon. This can cause very small tears to develop in your tendon. Without treatment, these tears won’t heal and your tendon can get weaker.

You may be more likely to get Achilles tendinopathy as you get older. This is because your Achilles tendon becomes less flexible as you get older and less able to cope with strain.

You may also be more at risk of Achilles tendinopathy if you:

  • have a family history of the condition
  • have injured your tendon or muscles around it in the past
  • have a long-term health condition, such as arthritis, diabetes, high blood pressure or thyroid problems
  • are very overweight or obese
  • have high cholesterol levels
  • take an antibiotic belonging to the quinolone group
  • wear the wrong sort of shoes or ones that don’t fit properly — especially if they push on the back of your heel
  • have a high-arched or low-arched foot — this can put more strain on your Achilles tendon

Sports and other activities can put a lot of stress on your Achilles tendon. You may be more likely to damage your tendon if you’re a runner or cyclist or do anything that involves jumping, such as dancing or tennis. You may also increase your risk of damage if you:

  • use badly designed equipment, including wearing the wrong footwear
  • suddenly increase how much exercise you do
  • train on hard, slippery or slanting surfaces
  • exercise in extreme weather conditions, especially the cold

Prevention of achilles tendinopathy

There are several things you can do to help prevent Achilles tendinopathy.

  • If you have underlying health problems that put you more at risk, make sure they’re being treated properly.
  • Lose weight if you’re overweight to reduce the strain on your Achilles tendon.
  • Make sure your shoes fit properly. They should have a lace-up fastening that keeps your heel in place. There should be enough room at the top so your toes can move around freely.
  • Whether you’re working or exercising, make sure you use the right equipment and techniques.
  • Limit repetitive motions that overuse your tendon.
  • Whatever exercise you do, build up slowly. Gradually increase the intensity and the length of time you spend being active.
  • Warm up your muscles before you exercise and cool them down after you’ve finished.

If you’re putting too much strain on your Achilles tendon, a podiatrist may be able to help. A podiatrist specialises in conditions that affect the feet and can analyse the way you walk. They can also advise you about wearing the right footwear to suit your feet, posture and activities. For more information see the FAQ ‘Which shoes will help avoid Achilles tendinopathy?’.

Wearing orthotics (special inserts) in each shoe may help to treat and prevent Achilles tendinopathy. These may help if there’s a problem with the shape of your foot or the way your foot works. If you have a low foot arch, this increases the stress on your Achilles tendon. You can buy orthotics from pharmacies or other retailers or they can be custom-made for you by a podiatrist. Ask your physiotherapist or podiatrist for advice.

Frequently asked questions about Achilles tendinopathy

  • It can take weeks or even months to recover from Achilles tendinopathy. The sooner you're diagnosed and start your treatment, the more quickly you’ll get better. In most people, the pain and movement get better after around 12 weeks. For more information see ‘Achilles tendinopathy treatment’.

  • Wearing well-fitting shoes can help to prevent Achilles tendinopathy and stop it coming back. The right shoes for you will depend on when, where and why you’re wearing them. This will also depend on the shape of your feet and how you walk. You may need different shoes for different sports. A podiatrist can give you advice.

    For running, you’ll need to wear well-padded running shoes rather than fashionable trainers. Running shoes will give your feet and ankles the right support. A specialist sports shop can assess your feet and posture to help you choose the right shoes.

    Wearing high heels can put extra stress on your Achilles tendon, especially if you have a low arch, so try not to wear high heels very often. Walking barefoot indoors may help to ease the stress on your tendon if you have a low arch.

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Related information

    • Pain in the Achilles region. Brukner & Khan’s Clinical Sports Medicine: Injuries, Chapter 40. Volume 1, 5e. New York, NY: McGraw-Hill.
    • Achilles tendinopathy. Clinical Knowledge Summaries., last revised January 2016
    • Achilles tendon injuries. Medscape., updated September 2018
    • Achilles tendon. British Orthopaedic Foot and Ankle Society., accessed April 2019
    • Achilles tendinopathy and rupture. PatientPlus., last edited June 2016
    • Tendinopathy. BMJ Best Practice., last updated January 2019
    • Achilles tendinitis. The MSD Manuals., last full review/revision March 2018
    • Ankle injuries. PatientPlus., last edited February 2016
    • Running. The Society of Chiropodists and Podiatrists., accessed April 2019
    • O’Neill S, Watson J, Barry S. Why are eccentric exercises effective for Achilles tendinopathy? Int J Sports Phys Ther 2015; 10(4):552–62
    • Extracorporeal shockwave therapy for refractory Achilles tendinopathy. National Institute for Health and Care Excellence (NICE), December 2016.
    • Autologous blood injection for tendinopathy. National Institute for Health and Care Excellence (NICE), January 2013.
    • Chaudhry FA. Effectiveness of dry needling and high-volume image-guided injection in the management of chronic mid-portion Achilles tendinopathy in adult population: a literature review. Eur J Orthop Surg Traumatol 2017; 27(4):441–48
    • Ciprofloxacin. NICE British National Formulary., lasted updated March 2019
    • Kozlovskaia M, Vlahovich N, Ashton KJ, et al. Biomedical risk factors of Achilles tendinopathy in physically active people: a systematic review. Sports Med Open 2017; 3(1):20. doi:10.1186/s40798-017-0087-y
    • Shoes for sport. The College of Podiatry., accessed April 2019
    • Pes planus (flat feet). PatientPlus., last edited January 2016
    • Footwear at work. The College of Podiatry., accessed April 2019
  • Reviewed by Alice Windsor, Specialist Heath Editor, Bupa Health Content Team, July 2017
    Expert reviewer, Mr Damian McClelland, Trauma and Orthopaedic Consultant, and Clinical Director for Musculoskeletal Services at Bupa
    Next review due August 2022