Achilles Pain (Achilles Tendinopathy)


  • Originates mid part of back of lower leg with merging of gastrocnemius and soleus (calf muscles)
  • Inserts into back of heel
  • Inserts with a spiral rotation
  • Allows for energy transfer by coiling during stretch and recoil when released e.g. propulsion
  • Poorly vascularised
  • Does not have true synovial sheath but enveloped by paratenon which allows free movement
  • Made up of around 70% of type 1 collagen fibers


  • Will present as either insertional or non insertional – area of tenderness
  • Non insertional usually has spongy lump generally in area of poor vascularity 2-5cm from insertion
  • Thickening of tendon

Why does it happen

  • Not well defined
  • Appears biomechanical overload is a factor
  • Increased stiffness at ankle joint (poor calf range of motion) – increases tensile load on tendon
  • Rapid pronatory forces at rearfoot – increase whipping of tendon at rotation
  • Weight
  • Elevated cholesterol
  • Poor footwear – low heel counters (pumps, converses, flip flops, minimalist running footwear)
  • Training errors including footwear, surface, technique
  • Specific sports – jumping sports but not exclusively
  • Is not uncommon in sedentary patient – reduced ability to deal with load
  • Can also be adhesions between paratenon and Achilles
  • Cause of pain unknown leaning toward vascular-neural ingrowth of the tendon (neovascularisation) which has been shown to be high on power Doppler ultrasound scans of injure tendons


  • Remove the tissue stress
  • Reduce ankle stiffness – calf stretches
  • Eccentric exercises or Isometric exercise dependant on stage
  • Address any training errors – surface, technique, footwear, type
  • Address biomechanical factors with orthoses if necessary
  • Heel raises in footwear to reduce load on tendon

If conservative fail:

  • Injection therapy
  • Surgical