Foot

What It Is

Two line drawings of the calf from behind: on the right, the two heads of the gastrocnemius coming down from behind the knee and narrowing into the Achilles tendon at the heel; on the left, the same leg with the gastrocnemius cut away to show the flatter soleus underneath. — Both calf muscles narrow into the Achilles just above the heel — the tendon that takes the load with every push-off.

What Is the Achilles Tendon?

The Achilles tendon is an important structure in the back of the leg above the heel bone (known as the calcaneus). It connects the heel bone with the calf muscles. The Achilles tendon helps the foot point downwards (plantar flexion), for example when you push up onto your tiptoes (Guy's and St Thomas' NHS Foundation Trust, 2024).

What Is Achilles Tendinopathy?

Achilles tendinopathy (sometimes called Achilles tendonitis) is an injury to the Achilles tendon that causes signs and symptoms such as pain, swelling, stiffness and weakness. The pain is usually located at the back just above the heel. It is common to have pain and stiffness when you first get up in the morning, or when you start walking after resting (Guy's and St Thomas' NHS Foundation Trust, 2024). Typically the pain can be fine when walking but aggravated when running or exercising.

The cause of Achilles tendinopathy is repetitive strain, which is commonly referred to as microtrauma (lots of tiny injuries). Current thinking is that the tendon does not fully heal after each small injury, so damage builds up over time. This is why tendinopathy is now seen more as a "failed healing" problem in the tendon than as simple inflammation (Li and Hua, 2016).

Achilles tendinopathy can be acute (painful, quick onset) or very chronic, difficult to shift, and long-standing. The main problem is the constant force going through the Achilles, and the poor blood supply to part of the tendon, which makes healing slower (Li and Hua, 2016). Another problem is that changes in the tendon may have been building up for some time before you notice pain, so although you may have had "pain" in the Achilles for a few days, the problem may have been present far longer. Do not be surprised if it takes 6 to 9 months of rehabilitation before you can return to full activities without pain (Guy's and St Thomas' NHS Foundation Trust, 2024).

What Causes Achilles Tendinopathy?

Excessive use of the tendon: usually in runners, dancers or other activities that involve jumping.
Inappropriate footwear, training or exercise techniques.
A sudden increase in the intensity or amount of training.
Training on hard surfaces.
High arch in the foot (pes cavus).
Lack of flexibility (especially tight calf muscles).
A change in gait (the way you walk or run).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

Non-Surgical Treatment

Strengthening and gradually building up load on the tendon is a key part of treatment (Guy's and St Thomas' NHS Foundation Trust, 2024; American Academy of Orthopaedic Surgeons, n.d.). I can guide you through this with a graded loading programme, hands-on work for the calf, and advice on footwear and training. See the My Approach tab for how I work.

Relative rest: rather than complete rest, reduce the activities that load the tendon, such as walking or running for a long time, and keep fit with other exercise such as cycling or swimming (Guy's and St Thomas' NHS Foundation Trust, 2024). Complete rest is not advised, especially when the problem is long-standing.
Painkillers: Guy's and St Thomas' NHS Foundation Trust (2024) says painkillers can be used for short-term pain relief, and the American Academy of Orthopaedic Surgeons (n.d.) says anti-inflammatory medicines such as ibuprofen or naproxen can reduce pain enough to help you do your exercises. (This medicine information comes from Guy's and St Thomas' NHS Foundation Trust and the American Academy of Orthopaedic Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)
Ice: wrap ice in a towel and place it on the most painful area for up to 20 minutes at a time, removing it sooner if the skin goes numb (American Academy of Orthopaedic Surgeons, n.d.). This is most useful for pain and swelling in the early stages (Guy's and St Thomas' NHS Foundation Trust, 2024). Never put ice directly on your skin.
Footwear, insoles and heel lifts: supportive footwear is better than flat shoes (Guy's and St Thomas' NHS Foundation Trust, 2024). Shoe inserts (orthotics) or a small heel lift can reduce the strain on the tendon, particularly where it attaches to the heel (American Academy of Orthopaedic Surgeons, n.d.). I can advise on footwear and heel lifts, and point you to a chiropodist or podiatrist if you need custom orthotics.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Shockwave therapy: a treatment that sends pulses of energy (shockwaves) into the painful part of the tendon, which may be considered if symptoms do not improve with a good exercise programme (Guy's and St Thomas' NHS Foundation Trust, 2024; American Academy of Orthopaedic Surgeons, n.d.).
Steroid injections: doctors generally do not recommend steroid (cortisone) injections around the Achilles tendon, because they can weaken the tendon and cause it to tear (American Academy of Orthopaedic Surgeons, n.d.).
Surgery: when long-term non-surgical treatment has not worked, an operation to remove damaged tendon tissue (debridement) may be considered; possible complications include ongoing pain and wound infection (American Academy of Orthopaedic Surgeons, n.d.).
Other surgical procedures: these include making lengthways cuts in the tendon to encourage healing, or freeing up the tendon from the tissue around it (tendon stripping) (Li and Hua, 2016).

How I can help (see the My Approach tab)

A graded loading and strengthening programme for the tendon

Hands-on work for the calf and lower leg

Footwear, training and taping advice

Treatment

My Approach

Achilles tendon pain responds best to the right amount of load: not complete rest, and not pushing through pain. My aim is to settle the tendon down, then build its capacity back up gradually so it copes with walking, running and sport again.

I start by assessing how your foot, ankle and leg move, testing your calf strength, and asking about your training, footwear and what brings the pain on. Pain right at the back of the heel bone is treated a little differently from pain higher up the tendon, so this shapes the plan.

Load Management

Cutting back the activities that aggravate it while keeping you active with things like cycling or swimming
Using the next morning as our guide: if morning pain and stiffness are stable or improving as we add load, we're on track; if they're climbing, we ease off

Strength and Loading

We start with pain-free holds: rising onto your toes and holding still
Then slow calf raises, then lowering slowly on the sore side, then single-leg raises, built up gradually rather than all at once
Lowering exercises need to be learned with guidance first, so I'll coach you through them in the session
Sit-to-stands and work for the hips and thighs so the whole leg shares the load
A home programme between visits and, when you're ready, gym-based strength work and a graded return to running or sport

Hands-On Treatment

Work through the calf and the rest of the leg to ease tension pulling on the tendon, including myofascial and trigger point work
Once it's past the early irritable stage, cross-fibre work on tight, stuck-down spots in and around the tendon, followed by gentle stretching and a short cool application
If your pain is right at the back of the heel bone, I keep stretching gentle, because deep calf stretches and hanging your heel off a step can squeeze the tendon there

I'll also look at your footwear, training habits and how your foot and leg line up. A small heel lift or shoes with a bit of heel height can take strain off, and taping can help in the short term. Long-standing tendon pain can take months to settle, so consistency matters more than speed.

If you feel a sudden pop or snap in the back of your leg, stop and get urgent help (see When to Get Urgent Help).

What to Expect

Typical Course

Typical course: Most people start with visits once or twice a week while we settle the tendon and set up your loading, then weekly, then spacing out as you manage your programme on your own, with a reassessment at about 4 to 6 weeks. Progress is usually steady rather than quick, and it commonly takes 6 to 9 months of rehab to get back to full activity without pain.

What I Focus On

Load Management

Isometric Loading

Progressive Calf Strength

Calf & Tendon Release

Footwear & Training Review

Please read

When to See a Doctor First

When to Get Urgent Help

If you feel a sudden pop or snap in the back of your calf or heel, you may have torn (ruptured) your Achilles tendon (American Academy of Orthopaedic Surgeons, n.d.). If this happens, call 911 or go to the emergency room at your nearest hospital.

Sources

References

Guy's and St Thomas' NHS Foundation Trust (2024) Achilles tendinopathy – overview. Available at: https://www.guysandstthomas.nhs.uk/health-information/achilles-tendinopathy (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Achilles tendinitis. OrthoInfo. Available at: https://www.orthoinfo.org/en/diseases--conditions/achilles-tendinitis/ (Accessed: 7 October 2026).
Li, H.-Y. and Hua, Y.-H. (2016) 'Achilles tendinopathy: current concepts about the basic science and clinical treatments', BioMed Research International, 2016, 6492597. doi: 10.1155/2016/6492597

Massage therapy · Kitchener–WaterlooAchilles Tendinopathy

What It Is

What Is the Achilles Tendon?

What Is Achilles Tendinopathy?

What Causes Achilles Tendinopathy?

Self-Care & Treatment

Non-Surgical Treatment

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

Load Management

Strength and Loading

Hands-On Treatment

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooAchilles Tendinopathy

What It Is

What Is the Achilles Tendon?

What Is Achilles Tendinopathy?

What Causes Achilles Tendinopathy?

Self-Care & Treatment

Non-Surgical Treatment

Treatments you may want to discuss with your family doctor or nurse practitioner

My Approach

Load Management

Strength and Loading

Hands-On Treatment

Typical Course

When to See a Doctor First

When to Get Urgent Help

References

Related Conditions

Calf Strain / Calf Tear

Plantar Fasciitis

Ankle Sprains (Medial and Lateral)

Shin Splints

Book a session