Overview

The Achilles tendon connects your calf (the back of the lower part of your leg) muscles to your heel bone. It helps you to push up onto your tiptoes.

Achilles tendinopathy is an injury to this tendon. Symptoms include:

• pain
• stiffness and swelling on the back of the heel
• the tendon might be warm and tender to touch
• the tendon might be red, swollen or thickened in appearance

If you are diagnosed with Achilles tendinopathy, this information can help you to manage it.

Diagnosing Achilles tendinopathy

You do not need an X-ray or other scans to diagnose Achilles tendinopathy. We usually confirm the diagnosis by asking about your medical history and examining you.

Causes of Achilles tendinopathy

The most common cause of Achilles tendinopathy is putting strain on the Achilles tendon. However, the causes of Achilles tendinopathy are not fully understood. There are lots of things that can contribute to it, such as:

• being overweight
• having tight or weak calf muscles
• having stiff ankle joints
• a sudden increase in activity levels, such as running, walking or playing sports
• training errors, including a lack of variety in training or too much hill running
• ongoing physical or mental health problems, which can make the symptoms worse

Managing pain

It is common to have pain when you get up in the morning, or when you start to walk after resting for a while. 

The level of pain can change. For example, you might feel better when you keep moving. Your tendon might be painful when you put weight on it after activity such as walking or running.

To help pain in the short term, you can try the following.

Relative rest

Relative rest is when you rest the injured part of your body, but continue to exercise the other parts of your body.

It can help to reduce the activities you do on your feet, such as walking or running for a long time. You can keep fit by doing other types of exercise, such as cycling or swimming.

Pain relief

You can use painkillers for short-term pain relief.

Ice

You can wrap ice in a towel and put it on the affected area. This can help with pain and swelling in the early stages. Do not put ice directly onto your skin.

Footwear

It is best to choose supportive footwear rather than flat shoes.

Exercises for Achilles tendinopathy

If you do exercises to strengthen the Achilles tendon, this can help your injury to heal. It can also help you return to activity.

You can do the following exercises in the early and later stages of rehabilitation. Your physiotherapist might show you some other exercises.

You need to follow the instructions and monitor how you do these exercises carefully. The exercises are intended to help you recover, but overloading the tendon might make your pain worse.

If you have any questions or concerns, please speak to your physiotherapist.

Exercise 1 (early stage)

1. Stand on the edge of a step, holding a handrail for support.
2. Your heels should be over the edge of the step.
3. Hold this position for 20 to 30 seconds, then step down and rest.
4. Repeat this exercise 3 times.

Exercise 2 (early stage)

Follow the instructions for exercise 1, but do the exercise standing on 1 foot.

Exercise 3 (later stage)

1. Stand on the edge of a step, holding a handrail for support.
2. Your heels should be over the edge of the step.
3. Lift up onto your toes.
4. Slowly lower back to the starting position. Do not drop your heels lower than the step.
5. Do this 10 to 12 times.
6. Rest and then repeat this exercise 3 times.

Exercise 4 (later stage)

Follow the instructions for exercise 3, but do the exercise standing on 1 foot.

Time it takes to recover

Everybody improves differently. Most people need 6 to 9 months of rehabilitation before they can return to full activities without pain.

It is normal to have some periods of increased pain or flare-ups during your recovery. If this happens, there are things you can do to manage your pain in the short term.

If you symptoms do not improve in 6 to 9 months (even after following an appropriate exercise programme), we can consider other treatment options. They include shockwave therapy. This treatment sends impulses of energy called shockwaves to the painful part of your foot.

Your physiotherapist can explain how shockwave therapy might help with your pain and other symptoms.