Achilles tendinopathy is a common cause of pain and stiffness at the back of the ankle, particularly in runners, people who play court and field sports, and those who are on their feet a lot. It often creeps up slowly, starting as morning stiffness that eases as you warm up, before becoming more persistent.
Tendons respond well to the right kind of load and poorly to the wrong kind. Knowing what tends to help, and what is likely to keep the tendon irritated, can make a real difference to how your recovery goes.
What is Achilles tendinopathy?
The Achilles tendon connects your calf muscles to your heel bone. It stores and releases energy every time you walk, run or jump. Achilles tendinopathy describes pain and reduced function in the tendon, usually linked to a change in the structure of the tendon in response to overload.
There are two main types. Midportion tendinopathy affects the tendon a few centimetres above the heel, while insertional tendinopathy affects the point where the tendon attaches to the heel bone. The distinction matters, because the way each is managed can differ. Our page on Achilles tendonitis and heel pain covers the symptoms in more detail.
What causes Achilles tendinopathy?
The most common driver is a change in load that the tendon has not had time to adapt to. This might be an increase in running distance or speed, adding hill or sprint work, returning to sport after a break, or changing footwear.
Other factors that may contribute include reduced calf strength, previous lower limb injury, higher body weight, and some health conditions such as diabetes or high cholesterol. Certain medications, including fluoroquinolone antibiotics, have also been linked to tendon problems, so mention any recent medications to your GP.
What helps Achilles tendinopathy?
Research consistently suggests that progressive exercise is the foundation of managing Achilles tendinopathy. The aim is to gradually build the tendon's capacity to handle the activities you want to do. Things that may help include:
Load management: reducing, not stopping, the activities that aggravate the tendon, such as sprinting, hills or jumping
Isometric exercises: holding a calf raise position can be a useful starting point when the tendon is irritable
Progressive calf strengthening: slow, heavy heel raises, both with a straight and bent knee, gradually increasing weight over weeks
Energy storage work: once strength improves, adding hopping, skipping and running drills to prepare the tendon for sport
A short-term heel lift: can reduce strain on the tendon, particularly for insertional pain
Supportive hands-on care: soft tissue work, dry needling or massage may help with calf tightness and pain as part of an exercise-based plan
Many practitioners use a pain monitoring approach. Mild discomfort during exercise, around 3 out of 10 or less, is often acceptable, as long as it settles within 24 hours and the tendon is not stiffer the next morning. A physiotherapist can help you set the right starting point and progress safely.
What should you avoid with Achilles tendinopathy?
Some common approaches can slow recovery or keep the tendon sensitive. It is generally wise to avoid:
Complete rest: pain may settle, but the tendon loses capacity, so symptoms often return when you go back to activity
Pushing through sharp or increasing pain: especially with high-speed or jumping activities
Big jumps in training: such as doubling your mileage or adding hill sprints all at once
Aggressive calf stretching for insertional pain: stretching over a step can compress the tendon against the heel bone and may aggravate symptoms
Relying on passive treatment alone: massage, needling or taping may help pain, but they are not a substitute for strengthening
Corticosteroid injections into the tendon: these are generally not recommended because of concerns about tendon weakening
How long does Achilles tendinopathy take to improve?
Tendons adapt slowly. Many people notice improvement within six to twelve weeks of a consistent exercise program, but returning fully to running or sport can take three to six months, and sometimes longer for long-standing or insertional cases.
Progress is rarely a straight line. A sensible approach to training load is key, and our blog on why runners get injured explains how load and recovery fit together.
When should you seek urgent care?
Seek prompt medical attention if you experience:
A sudden pop, snap or feeling of being kicked in the back of the ankle
Sudden inability to push off, rise onto your toes or walk normally
A gap you can feel in the tendon, or rapid swelling and bruising
Redness, heat and fever, or calf swelling and pain that could suggest a blood clot
These signs may indicate an Achilles rupture or another condition that needs urgent assessment, so do not wait to see if it settles.
What everyday habits can help settle your Achilles?
Small changes outside your exercise program can make the tendon feel less irritable while it adapts:
- Wear supportive, comfortable shoes and avoid long periods in very flat shoes or going barefoot on hard floors if it aggravates your pain
- Make gradual changes to footwear rather than switching to a very different shoe overnight
- Ease into the morning with gentle ankle movements before your first steps, as stiffness is often worst then
- Break up long periods of standing or walking on hard surfaces where you can
- Keep a simple diary of activity and next-morning stiffness to spot what your tendon tolerates
Could a running assessment help?
If running brought on your Achilles pain, looking at how you run and how your training is structured may help explain why. Factors such as sudden changes in pace, cadence, terrain or weekly volume can all affect tendon load. A running assessment can help guide a gradual return, alongside your strengthening program and broader sports injury care.
Frequently asked questions
Can I keep running with Achilles tendinopathy?
Many people can keep running at a reduced level, provided pain stays mild and settles by the next morning. Reducing speed, hills and distance for a period often helps. Your practitioner can help you modify your program rather than stopping altogether.
Is Achilles tendinopathy the same as tendonitis?
The terms are often used interchangeably, but "tendinopathy" is now preferred. Research suggests the problem is more about changes in tendon structure and load tolerance than ongoing inflammation, which is why exercise is the main focus of care.
Do I need a scan?
Often not. Achilles tendinopathy is usually diagnosed through a clinical assessment. Ultrasound or MRI may be suggested if the diagnosis is unclear, symptoms are not improving, or a tear is suspected.
Getting help on the Gold Coast
If Achilles pain is holding back your running, sport or daily walks, our team at The Good Joint in Mermaid Beach can assess your tendon and build a loading program that suits your goals. Learn more about our tendon care or book online.
Related reading: What causes plantar fasciitis and how is it treated? and What causes shin splints and how do you get back to running?
