Achilles Tendinopathy

Achilles Tendinopathy

The Achilles is the thick tendon which connects the calf muscle to the heel bone. It is heavily loading during running and is therefore a common culprit of injury when the load applied to the tendon exceeds what it can withstand.  This causes the tendon matrix to start to breakdown or degenerate. This injury can either be insertional, occurring at its insertion point at the heel or midportion occurring in the midsection of the tendon and like all tendinopathies it exists on a continuum, which indicates the stage of tendon degeneration and will determine how it is managed.

The three stages of tendinopathy are:

  • Reactive tendinopathy: early non-inflammatory phase of injury in which the tendon thickens and stiffens to try and reduce stress and cope with overload.
  • Early tendon disrepair: a progression from the reactive phase in which the tendon matrix begins to breakdown and cells become disorganised.
  • Degenerative tendinopathy: late stage tendinopathy in which the matrix and cell changes have progressed so that large areas of the matrix are broken down.

The first two stages of tendinopathy are quite reversible if managed early and correctly. Once the tendon has progressed to being degenerative it is much harder to rehabilitate so it is important to seek physiotherapy advice or treatment at the first sign of injury.


Symptoms will usually onset gradually without any specific incident of injury. Pain can be felt at the heel if insertional or in the tendon on the lower aspect of the calf if midportion. Pain and stiffness is typically worse first thing in the morning and at the start of exercise and may reduce after warming up. When more severe pain may be present with just walking and there may be some swelling or painful nodules through the tendon.


Acute or chronic overload is the major cause of any tendinopathy which can be a result of several different factors. Usually more than one factor contributes to its onset so it is important to be properly assessed by a physiotherapist so that all areas can be addressed in treatment. Factors may include:

  • Biomechanical issues including poor foot mechanics and calf weakness
  • Decreased calf flexibility and ankle mobility
  • Rapid increase in training load (intensity, mileage, terrain)
  • Inadequate recovery from training
  • Poorly fitted, excessively worn or change of footwear
  • Hard training surfaces 

Prevention and Treatment

Early treatment of this injury must include unloading of the tendon by a reduction in training load. Other techniques including icing, soft tissue therapy and bracing/taping may help to reduce the severity of symptoms and prevent injury progression.

For most effective long term management, the causes of the injury must be identified and managed per your physiotherapist’s judgement. This will normally include some stretching and strengthening exercises targeting the calves and stabilising muscles of the lower limb.

Prevention of the injury is gold standard treatment so ensuring that you are training smart, your footwear is correctly fitted and updated, avoid always training on hard surfaces such as roads and the track and have a regular stretching and strengthening routine which focuses on the calves, hip stabilisers and core.

Other Running Injury info:

  1. Plantar Fasciitis
  2. Achilles tendinopathy
  3. Patello-femoral pain syndrome
  4. Patella tendinopathy
  5. Calf Strains



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