Achilles tendinopathy is pain, stiffness and reduced strength in the Achilles tendon at the back of the ankle. It usually develops when the tendon is loaded more than it can cope with. Progressive strengthening exercise is the main recommended treatment.
Also known as Achilles tendonitis, Achilles tendinitis, Achilles tendon pain
Symptoms
- Pain in the tendon just above the heel, often 2 to 6 cm up
- Stiffness first thing in the morning or after sitting
- Pain at the start of exercise that may ease, then return afterwards
- Tenderness or a thickened feel when the tendon is squeezed
- Reduced spring or power when hopping, running or climbing stairs
Causes and risk factors
- A sudden rise in running, hill work or speed training
- Weaker calf muscles
- A previous tendon problem or lower leg fracture
- Getting older
- Some antibiotics called fluoroquinolones (quinolones)
What the evidence says helps
- A US clinical practice guideline (2024) gives its strongest recommendation to tendon-loading exercise. It suggests exercising at least three times a week at loads as high as you can tolerate.1
- Complete rest is not advised. The guideline recommends staying active within comfortable limits, alongside education about the condition.1
- A large review found active treatments did better than wait-and-see at 3 months. No treatment was clearly better than calf exercise, which is low-cost and low-risk.2
- Heel lifts may be used for short-term relief, and stretching may help if ankle movement is limited. Evidence for insoles is mixed.1
- A recent review found shockwave therapy gave no meaningful benefit over sham treatment, so it should not be a routine first choice.3
Things you can try at home
- Keep moving but reduce activities that make the tendon sore the next morning
- Start simple calf-raise exercises and build up the load over weeks
- Use a mild level of pain (around 3 out of 10 or less) during exercise as a guide, settling by the next day
- Reduce hill running and speed work for a while
- Tell your doctor or pharmacist about tendon pain if you are prescribed a fluoroquinolone antibiotic
When to get urgent help
Contact your GP urgently, call NHS 111, or call 999 in an emergency if you have:
- A sudden snap, kick-like feeling or sharp pain at the back of the heel, with trouble walking or standing on tiptoe: go to A&E, as the tendon may have ruptured
- Tendon pain that starts while taking a fluoroquinolone antibiotic: stop and seek medical advice the same day
- A hot, red, swollen calf with throbbing pain: get an urgent GP appointment or call NHS 111
- Calf swelling with chest pain or breathlessness: call 999
- Pain with fever or a red, hot heel: contact your GP or NHS 111
How Apollo can help
We assess where the tendon pain is, how it responds to load and how strong your calf is. We may use VALD strength testing to measure your calf and track progress. We then build a progressive tendon-loading programme, adjust your training load and plan your return to running or sport. Hands-on care may be used alongside exercise for comfort, and we refer on if we suspect a tear or another cause.
No GP referral needed. Clinics in Sheringham, Coltishall and Norwich.
Related reading
Frequently asked questions
Should I stop running with Achilles tendinopathy?
You do not usually need to stop completely. Guidance supports staying active within comfortable limits. Reduce hills and speed work and aim for pain that settles by the next morning.
How long does Achilles tendinopathy take to get better?
Tendons adapt slowly, so a strengthening programme usually takes at least 12 weeks to show its full effect. Some people need several months. Sticking with the exercises is key.
Is Achilles tendinopathy the same as tendonitis?
People often use the words interchangeably. Tendinopathy is now preferred because the problem is mainly a change in tendon structure and load tolerance, not just inflammation.
References
- Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL (2024). Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2024. Journal of Orthopaedic & Sports Physical Therapy. View source
- van der Vlist AC, et al. (2021). Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. British Journal of Sports Medicine. View source
- Korakakis V, et al. (2026). Shockwave therapy for midportion and insertional Achilles tendinopathy: a nail in the coffin? A systematic review with meta-analysis. Journal of Orthopaedic & Sports Physical Therapy. View source
- Wang Y, et al. (2022). Prevalence of Achilles tendinopathy in physical exercise: a systematic review and meta-analysis. Sports Medicine and Health Science. View source
This page is general information, not a diagnosis or a substitute for medical advice. If you are worried about your symptoms, speak to your GP or a registered healthcare professional. Content prepared from the sources above, November 2026.
