Conditions

Achilles Tendinopathy (Achilles Tendon Pain)

A tendon connects muscle to bone. The Achilles tendon connects your calf muscles to your heel bone. It is the strongest tendon in the body and helps you walk, climb stairs, run and jump. Any tendon can develop tendinopathy, which means the tendon has become painful and is not coping well with the loads placed upon it. The tendon may become painful and stiff, and it may not tolerate activities as well as usual. Swelling is sometimes present but not always.

Achilles Tendinopathy

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Common symptoms include pain, stiffness and sometimes swelling at the back of the heel. The pain may spread into the calf. Pain may feel dull, aching or sharp depending on the activity. The pain is often noticeable when getting up in the morning or when taking your first few steps after resting. Often people have pain when walking, using stairs and when running or playing sports. Recovery often takes several months, but most people improve with the right combination of activity modification and progressive strengthening exercises.

Achilles tendinopathy usually develops when the tendon is asked to do more than it is ready for. This might happen after increasing walking, running or sporting activities, changing footwear, or after a period of reduced activity. People with diabetes, obesity or those who smoke are more likely to have tendon issues.

Steps to take to recovery

Self-Management

Activity Modification

Try to keep moving while temporarily reducing activities that significantly increase your pain. Completely avoiding activity for long periods can slow recovery because tendons respond well to gradual loading. Gradually return to your normal activities as symptoms improve. If standing or walking aggravates your symptoms, reducing these activities for a short period may help settle a flare-up.

Pain Relief

Over-the-counter medicines: Over-the-counter pain relief may help you stay active. Always follow the advice provided with the medicine.

Topical creams: Some people find topical creams or gels helpful for short-term relief of pain and stiffness.

It is important to check whether you can take these medicines. If you are unsure whether you can take these medicines, speak to a pharmacist or another healthcare professional.

Exercises

Progressive strengthening exercises are one of the most effective treatments for Achilles tendinopathy. Exercises should gradually load the tendon to improve its strength and ability to cope with everyday activities. It is normal to experience some discomfort during these exercises provided symptoms settle afterwards and are not significantly worse the following day. Exercises for the feet and ankles from Arthritis UK may help. Gentle stretching may help some people, but strengthening exercises are usually more important than stretching for long-term recovery.

Wear Supportive Footwear

Poorly fitting footwear can sometimes contribute to foot and ankle pain. Choose comfortable, supportive footwear with enough room for your toes where possible.

Weight Management

If you are carrying extra weight, even a modest amount of weight loss can reduce the load through the foot and ankle and improve symptoms. You can calculate your BMI using the NHS BMI calculator.

Heel raise

A temporary heel raise (around 6–10 mm) inside your shoe may reduce strain on the tendon during painful flare-ups. This should usually only be used for a short period while symptoms settle. These can be purchased online and inserted into your shoes.

Further Treatment

Podiatry

If your symptoms are not improving or you feel you need more support, you can refer yourself to the podiatry service. The podiatry team can assess your biomechanics, provide insoles, an exercise programme and shockwave treatment.

You don't need to refer to both podiatry and physiotherapy. If you feel you only need an exercise programme, further investigation or surgery then physiotherapy would be appropriate. If you feel you need biomechanics assessment, insoles, exercises and possible shockwave treatment the podiatry would be appropriate.

Physiotherapy

If your symptoms aren't improving or you feel you need more help, then please refer yourself to physiotherapy . We will assess your symptoms and work with you to develop a treatment plan. You can have one-to-one physiotherapy and have access to our gym classes. Our service can offer advice and an exercise programme. If people are not improving we can also refer you to a orthopaedic surgeon if required.

Diabetes

If you have diabetes and develop foot pain, discuss this with your GP or diabetes team. People with diabetes are at increased risk of developing foot problems and may need assessment sooner. Your GP or diabetes team can ensure you are receiving the most appropriate treatment.

Lifestyle factors that influence health

Achilles tendinopathy is a common condition and is influenced by our overall health. Activity levels, rapid increases in walking or running, muscle strength, weight, smoking, diabetes and overall health can all influence Achilles tendon symptoms. Improving general health, staying active, gradually strengthening the tendon, and addressing lifestyle factors can help improve symptoms. More support with health and lifestyle factors can be found on our Your Musculoskeletal Health webpage.

When to seek further advice

Some symptoms require urgent medical assessment rather than physiotherapy or podiatry. Please seek urgent medical advice if you have any of the following:

A fall or injury causing severe pain, significant swelling or a sudden loss of movement
Severe foot pain with an inability to bear weight
A red, hot, swollen and painful foot, ankle or calf
You felt a snap or pop at the time of the injury, particularly if you are unable to push up onto your toes or walk normally

If any of the above apply to you, contact NHS 111 for advice or attend your nearest Emergency Department if your symptoms are severe.