What Is Achilles Tendinopathy?
Achilles tendinopathy (sometimes referred to as Achilles tendinitis) is a condition characterised by pain, stiffness, swelling, and weakness in the Achilles tendon, the large tendon connecting your calf muscles to your heel bone. It’s one of the most common overuse injuries we treat at our Melbourne clinics, affecting runners, athletes, and active individuals of all levels.
Tendinopathy is the broader, more accurate clinical term. Where tendinitis describes acute inflammation, tendinopathy refers to the degenerative changes that occur in the tendon tissue with ongoing or repeated overload, which is what most patients are actually dealing with by the time they seek treatment.
What Causes It?
Achilles tendinopathy develops when load on the tendon consistently exceeds its ability to recover. Common contributing factors include:
- A sudden increase in training intensity, volume, or frequency
- Tight or weak calf muscles, placing excess strain on the tendon
- Inadequate footwear, particularly shoes with insufficient heel-to-toe drop
- Changing training surfaces (e.g. road to trail, grass to hard court)
- Biomechanical issues such as overpronation or altered gait patterns
- Returning to activity too quickly after a period of rest or illness
- Age-related changes in tendon tissue strength and elasticity
Signs You May Have Achilles Tendinopathy
- Pain or stiffness at the back of the heel or lower leg, which often worsens with the first steps in the morning
- A burning, pulling, or shooting pain during or after activity
- Swelling or thickening along the tendon
- Achilles heel pain that warms up with movement but returns after prolonged walking or exercise
- Tenderness when pressing on the tendon
- Reduced strength or range of motion in the ankle
Don’t ignore burning pain along the Achilles. It’s one of the earliest warning signs that the tendon is under significant load. Catching it early leads to a much shorter recovery.
How To Treat Achilles Tendinopathy
Achilles tendinopathy treatment is most effective when it addresses both the immediate pain and the underlying load pattern.
Immediate Treatment
Manage acute soft tissue injuries using the RICER protocol: Rest, Ice, Compression, Elevation, and Referral. Follow this for 48–72 hours to minimise joint bleeding and damage.
The No HARM protocol should also be applied – No Heat, No Alcohol, No Running or activity, and No Massage. This will ensure less bleeding and swelling in the injured area.
Treatment includes rest, pain relief, strengthening exercises, and changes in sports techniques and footwear to reduce stress on the tendon. Orthotic therapy and surgery may also be indicated.
Treatment and Rehabilitation by a Podiatrist
Recovery can take weeks to months, depending on how long the condition has been present. The sooner treatment begins, the faster and more complete the recovery.
Once pain has settled, exercises and stretches may be prescribed to strengthen the tendon to cope with the load and return to activity.
Other treatments may include ultrasound therapy, mobilisation, dry needling, stretching, massage and orthotics. Anti-inflammatory medication may also be indicated.
A completely ruptured Achilles will require a surgical referral. Return to activity must be gradual, usually aided with heel raises and taping.
Why Choose Highett Podiatry?
Achilles tendinopathy is one of the most common presentations at our Highett and Mentone clinics, and we have extensive experience managing it across runners, team sport athletes, and everyday patients.
At our Highett and Mentone clinics, we provide specialised care, including treadmill gait analysis utilising video technology, dry needling, and other tailored treatments. Schedule a consultation with our podiatrists today.