Achilles Tendinopathy

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What is Achilles Tendinopathy?

Tendinopathy is a term used to describe overuse. Achilles tendinopathy describes an overuse condition in the Achilles region. There are 2 types of Achilles tendinopathy: midportion and insertional. There are different stages of tendinopathy. Early stage tendinopathy shows changes in the cells in the area and in later stages there are disruptions of the cells as well as collagen disruption and an increase in blood vessels. The changes that are present in early stage tendinopathy are reversible however once the injury progresses into the chronic phase permanent changes may be present.

What causes Achilles Tendinopathy?

Injury to the Achilles can occur in a single episode or more commonly over a period of time where the tendon is unable to withstand the load placed on it. Factors that may predispose a person to Achilles Tendinopathy are:

  • Abnormal foot mechanics
  • Calf weakness.
  • Altered shin or thigh mechanics.
  • Genetics.
  • Being male.
  • Menopause.
  • Type 2 diabetes.
  • Years of running.
  • Poor muscle flexibility.
  • Stiff ankle joints.

Other factors that may make someone more susceptible include:

  • Decreased recovery time between training sessions.
  • Change of surface.
  • Change of footwear (lower heeled spike, shoes with heel tab).
  • Poor footwear, footwear wearing out.
  • Increase in activity (mileage, gradient, speed).

How does it feel?

The presentation of Achilles tendinopathy can be mixed.  Patients typically report an insidious onset of pain. The severity may range from a minor inconvenience to very severe pain, even with walking. The duration varies from a few days to years and it ranges in disability from minor, moderate to severe. Patients typically notice a stiff feeling in the morning or at the start of exercise that may warm up and disappear. Patients may notice swelling developing in the area, with a tender nodule developing.

How is it managed?

Achilles tendinopathy generally doesn’t get better on its on own. It will feel a little bit better with rest but once you start doing the aggravating exercise or activity again it will become painful again. Continuing to do aggravating activities may advance the process and may significantly prolong the recovery time. 
The goals of treatment are to identify any predisposing factors, reduce pain and inflammation and promote healing to restore the muscle and tendon.

Early treatment may include:

  • Rest from provocative activities.
  • Ice
  • A targeted stretching and strengthening program.
  • Massage and soft tissue therapy.
  • Taping may be used to unload the muscle and tendon.
  • Dry needling.

Other things that may be used if the condition doesn’t settle are:

  • Corticosteroid injection.
  • Prolotherapy.
  • Surgery.
  • Blood injection.

The treatment for insertional Achilles tendinopathy varies slightly. It is usually associated with problems with the retrocalcaneal bursa and some of the surrounding cartilage as they are all closely related. Treatment of insertional Achilles tendinopathy is usually more difficult to treat because of the close relationship of the surrounding structures. Your physiotherapist will slightly change the rehabilitation program to accommodate this.

When can you return to sport or activity?

It is important that you return to sport or aggravating activities slowly. Depending on the severity of the initial condition and the length of rehabilitation, a graduated return may take 3 weeks or 3 months, your physiotherapist will guide you through this.

What is the prognosis?

Achilles tendinopathy, if treated and managed properly will not have any long term effects. If not, it can lead to prolonged pain and dysfunction , a prolonged period away from sport/work/aggravating activities and may cause degeneration of the tendons, causing lingering pain. The rehabilitation can be frustratingly slow but persevere, it will get better.


  • Seek treatment at an early stage
  • Ensure you physiotherapist provides you with methods of self treatment and management.