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Achilles-tendinopathy | Blog | Physio.co.uk | Leading physiotherapy provider in Liverpool and Manchester.

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What is it?

The Achilles tendon is a large structure that joins the calf muscle complex to the heel bone. This is the largest tendon in the human body and is subjected to huge amounts of loads and forces, which can sometimes result in overloading and therefore injury.

When a tendon becomes overloaded, we refer to it as a tendinopathy (or ‘tendinitis’ as it is more commonly known), which simply means ‘tendon-disorder’.

Achilles Tendinopathy

What do Achilles injuries look like?

Patients will often present with;

  • Pain around the back of the ankle
  • Report recent changes in activity levels
  • Localised swelling or a small nodule on the tendon
  • Intermittent pain at the beginning or at the end of exercise
  • Pain on movement after sitting for a long period or when waking from sleep

There are two types of Achilles tendinopathy:

  • Mid-portion – which usually occurs 2-6cm above the insertion of the tendon at the heel and this happens in 55-66% of cases
  • Insertional – happens at the insertion point of the Achilles to the ankle bone

This is important to know as it will it affect the way that treatment is delivered by therapists.

 What causes these types of injury?

Tendon pathologies are generally caused by the exertion of loads and forces the tissue is unaccustomed to. This can happen in several ways, such as:

  • Starting a new activity that the tendon is not prepared for
  • Adopting poor technique
  • Changing of training environments (eg running up/downhill or change of running surface)
  • Footwear alterations
  • Changing the intensity or frequency of training too rapidly 

Who is most likely to get it?

Due to the high loads transmitted through the Achilles when training, running, jumping etc you are more likely to develop tendon injuries if you are physically active. It is estimated that up to 29% of runners may experience Achilles tendinopathy at some point.

Inactive individuals have a reduced risk, with 4 in 100 people developing Achilles tendon injuries despite their low levels of activity. There is also evidence to suggest that the following factors also increase your chances of developing these injuries:

  • Increased Body Mass Index (BMI)
  • High blood pressure
  • High cholesterol levels
  • Diabetes
  • Altered biomechanics of the foot and ankle
  • Use of corticosteroids and some antibiotics (ie fluroquinolines)
  • Family history

Achilles Tendinopathy

What else could it be?

There are a number of other conditions that may present similarly, such as:

  • Sciatica
  • Calcaneal (heel) bursitis
  • Gout
  • Calcaneal fracture
  • Nerve impingement
  • Haglands deformity/bone spurs  

An experienced physiotherapy will be able to differentiate between these conditions during assessment, before provided the appropriate course of treatment.

How do we fix it?

Our highly trained physios will provide an individually tailored treatment plan, which may involve the following factors:

  • Relative rest
  • Avoidance of aggravating factors/activity modifications
  • Look at footwear and consider use of orthotics
  • Potentially use taping techniques to offload affected tissues
  • Sometimes utilise ice and rest depending on the severity
  • Loading exercises

–      Selecting specific loading exercises

–      Stretching programme (only if appropriate)

  • Progression of loading
  • Increase amount of loading
  • Eventually plyometric (quick) loading or controlled landing programme (if required)
  • Soft tissue work
  • Specific soft tissue mobilisations
  • Addressing biomechanics
  • Are any postural factors that contributed to the overload?
  • Is there any balance issues?
  • Is there any weaknesses and imbalances up the ‘kinetic chain’ (further away from the source of pain)?
  • Return to function
  • Gradual return to training
  • Continued strengthening program and addressing biomechanical factors

Achilles Tendinopathy

What are the outcomes like?

Tendons tend to adapt slower than muscle and other soft tissue because they have a slightly reduced blood supply.

Therefore, the recovery rates may vary and so we say that it could take between 2 to 4 months to make a good recovery from symptoms (however, this will depend on severity of injury and response to treatment).  Research demonstrates that physiotherapy is accepted as a leading method of managing tendon injuries, with successful results shown across short and long term studies.

Successful rehabilitation will see the condition improve steadily- pain and swelling will reduce and function will begin to return. It is important to ensure that rehabilitation programmes are carefully designed for each individual patient, with a carefully graded return to activity to minimise the chances of delayed healing or re-injury.

If you suspect that you have a tendon problem, please do not hesitate to contact our team to arrange an assessment with one of our physiotherapists by contacting us on 0330 088 7800 or by visiting physio.co.uk.


Asplund, C. & Best, T. (2013). Achilles Tendon Disorders. BMJ 346 doi: 10.1136/bmj.f1262

Cook, J. (2013). Tendons and tendinopathy with Jill Cook. Physioedge Podcast. http://physioedge.com.au/pe-005-tendons-and-tendinopathy-with-jill-cook/

Holmes, G.B. & Lin, J. (2006) Etiologic factors associated with symptomatic achilles tendinopathy. Foot Ankle Int 27(11): 952-9.

de Jonge, S. (2013) Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements. Scand J Med Sci Sports doi: 10.1111/sms.12072

Kozlovskaia, M. et al. (2017). Biomedical Risk Factors of Achilles Tendinopathy in Physically Active People: a Systematic Review. Sports Medicine Open 3(1):20