Conditions / Heel & Ankle
Achilles Tendonitis & Tendinopathy
Expert assessment and rehabilitation to reduce pain, restore strength and get you back to activity safely. We identify whether you have mid-portion or insertional tendinopathy and build a plan accordingly.
The Achilles tendon connects your calf muscles to your heel bone and is the largest tendon in the body. Tendonitis refers to short-term inflammation, while tendinopathy is a more accurate term for longer-term tendon pain and thickening caused by overload. Both present similarly — but the distinction matters for treatment.
There are two distinct types, each with a different location, presentation, and treatment approach:
Mid-portion Achilles Tendinopathy
Pain 2–6cm above the heel bone. The most common type, associated with overload and typically responds well to progressive loading.
Insertional Achilles Tendinopathy
Pain where the tendon attaches to the heel bone. Requires a modified approach — certain exercises used for mid-portion can aggravate this type.
Morning stiffness or pain with first steps
Tendon pain that eases as you warm up, then returns after activity
Thickening or tenderness along the tendon
Pain with running, jumping or uphill walking
Increased pain after prolonged sitting or inactivity
Gradual onset over weeks — rarely sudden
Training Load Spike
A sudden increase in running volume, speed or hill work is the most common trigger for Achilles tendinopathy.
Calf Weakness
Insufficient calf and soleus strength reduces the tendon's ability to manage load, increasing strain with each step.
Footwear Change
Switching to lower heel-drop or minimal footwear increases tensile load on the Achilles significantly.
Foot Biomechanics
Altered foot mechanics during gait can place extra demand on the tendon over thousands of steps.
Most cases are diagnosed clinically without imaging. Your podiatrist will assess calf strength, tendon loading tolerance and foot biomechanics to determine the type and severity of your tendinopathy and identify contributing factors.
Where symptoms are unusual or not improving with treatment, we can arrange ultrasound or MRI referral to confirm the diagnosis and rule out partial tears or other pathology.
We use an evidence-based approach tailored to your type of tendinopathy, activity level and goals. The key principle is progressive loading — tendons respond to controlled stress, not rest.
01
Avoid sudden increases in running volume, speed or hill sessions
02
Wear supportive footwear — avoid flat, unsupportive shoes or sudden switch to minimal drop
03
Apply ice after activity if the tendon is irritated — 10–15 minutes wrapped in a cloth
04
Complete your prescribed loading exercises consistently — tendons need progressive stress to heal
6 – 8 weeks
Early-stage cases
Recent onset tendinopathy with consistent rehabilitation often sees significant improvement within 6–8 weeks.
8 – 12 weeks
Moderate cases
Most people with moderate tendinopathy improve within 8–12 weeks with a structured loading programme.
3 – 6 months
Chronic cases
Long-standing cases — especially insertional — take longer. Shockwave therapy significantly improves outcomes in persistent cases.
If Achilles pain has lasted more than 2–3 weeks, is limiting your activity, or keeps returning after rest, book an assessment. Early, accurate diagnosis — mid-portion or insertional — is essential, as the wrong rehabilitation programme can make symptoms worse.
Don't wait for it to resolve on its own — untreated or poorly managed tendinopathy frequently becomes chronic and significantly harder to treat.
Do I have to stop exercising completely?
Not usually. Complete rest is rarely appropriate for tendinopathy — tendons respond to load, not inactivity. We guide you on how to stay active while reducing stress on the tendon during recovery.
How long does recovery take?
Most people with mid-portion tendinopathy improve significantly within 8–12 weeks of consistent treatment. Insertional tendinopathy and long-standing cases typically take longer — 3–6 months — and may benefit from shockwave therapy.
Do I need a scan?
Usually not. The diagnosis is made clinically from your history and examination. Imaging is only needed if your symptoms are unusual, not improving as expected, or if we need to rule out a partial tendon tear.
Are cortisone injections recommended?
Cortisone injections are generally avoided near the Achilles tendon due to the risk of tendon rupture. We focus on safe, evidence-based alternatives — progressive loading, shockwave therapy, and load management — which have a strong track record.
Ready to get rid of your Achilles pain?
Book an assessment and we'll identify the type, cause, and build a structured plan to get you back to full activity.
