Achilles tendinopathy is an overuse problem of the tendon connecting the calf to the heel, causing pain, stiffness and swelling that is worst on the first steps after rest. Most people recover with a structured loading programme and load management. It is not the same as an Achilles rupture.
Symptoms
- Morning stiffness that eases after 10–15 minutes
- Tenderness and thickening of the tendon
- Pain after exercise rather than during it
- Two patterns: mid-portion (2–6 cm above the heel) and insertional (at the heel bone)
- A sudden pop with inability to push off can mean a rupture — seek urgent care
Causes & risk factors
- Spikes in training load
- Tight calf muscles
- A switch to minimalist footwear
- Certain medications (fluoroquinolone antibiotics, corticosteroids)
- A bony heel prominence (Haglund's) in insertional disease
Conservative treatment comes first
- A structured loading programme (Alfredson eccentric for mid-portion; isometric-to-isotonic for insertional)
- Load management
- Shockwave therapy (ESWT) after 8–12 weeks, arranged externally
- A bursa injection for selected insertional cases — steroid is never injected into the tendon itself
- PRP for resistant cases
When surgery is considered
Needed in fewer than 15–20% of cases. Options include debridement, removal of a Haglund's prominence and tendon reattachment. Return to running is usually around 5–6 months.
Questions & answers
Mid-portion disease often improves over 8 to 12 weeks; insertional disease can take up to a year.
Light running is reasonable if pain stays below about 4 out of 10 and settles to baseline within 24 hours.
No. Tendinopathy is gradual overload; a rupture is a sudden tear with a pop and weakness, and needs urgent care.
Steroid into the tendon raises the risk of rupture, so it is avoided. The reliable route is loading and, if needed, shockwave.
Sources & further reading
- NICE IPG571
- NICE IPG312
- BOFAS patient information
