Achilles Tendinopathy: causes, symptoms, and treatment options

The Achilles tendon — the strong band of tissue connecting your calf muscles to your calcaneus or heel bone — plays a critical role in walking, running, and jumping. When it becomes painful or irritated, everyday activities can become a real challenge. This condition, known as Achilles tendinopathy, is one of the most common overuse injuries in the lower extremities.

What Is Achilles Tendinopathy?

Achilles tendinopathy refers to irritation, pain, and sometimes degeneration of the Achilles tendon. It may occur at the midportion of the tendon or at its insertion point on the calcaneus. While it was once commonly referred to as “tendonitis,” current research shows that the condition is often degenerative rather than purely inflammatory — meaning the tendon fibers have weakened or thickened over time.

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Common Causes and Risk Factors

Achilles tendinopathy typically develops from repetitive stress or sudden changes in activity. Other common factors include:

● Overuse or increased training load – A sudden jump in running mileage or intensity can overload the tendon.

● Tight or weak calf muscles – Limited flexibility or strength imbalances can place extra tension on the tendon.

● Improper footwear – Worn-out or unsupportive shoes can alter how forces travel through the foot and ankle. Switching quickly from a shoe with significant heel-toe drop to a zero drop shoe can also cause problems.

● Age and activity level – Tendon elasticity naturally decreases with age and this can impact a person of any age.

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How Patients Typically Present

Patients with Achilles tendinopathy often report:

● Pain or stiffness in the back of the ankle or heel, especially during the first few steps in the morning or after periods of rest.

● Tenderness and thickening along the tendon or near the heel.

● Pain that worsens with activity, such as running, jumping, or climbing stairs.

● Decreased strength or performance, particularly during push-off movements.

Symptoms often begin gradually, making early recognition and management key to preventing chronic problems.

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Treatment Options and the Role of Physical Therapy

With the right treatment plan, most patients recover fully and return to their favorite activities. Physical therapy plays a central role in this process.

1. Activity Modification

Reducing or temporarily adjusting high-impact activities allows the tendon to begin healing. Cross-training options like swimming or cycling can help maintain fitness without excessive tendon stress.

2. Progressive Loading and Strengthening

Research strongly supports resistance exercises for Achilles tendinopathy. This can be either eccentric or heavy-slow resistance exercises and both show efficacy in treatment. These exercises strengthen the tendon and surrounding muscles, helping the tissue remodel and regain function.

3. Flexibility and Mobility Work

Improving calf muscle flexibility and ankle mobility can reduce strain on the tendon during activity.

4. Manual Therapy and Soft Tissue Techniques

Hands-on treatment may help improve tissue quality and reduce discomfort

5. Gait and Movement Retraining

Physical therapists can assess how you walk, run, or jump and make corrections to reduce excessive tendon loading.

6. Footwear and Orthotics Guidance

Proper shoes or inserts can help w/ symptoms in the short term.

It can often take 8-12 weeks to see changes so this process takes time to see improvement. It’s important to remember tendon changes occur slower than muscle fibers.

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When to Seek Help

If you’ve been experiencing Achilles pain for more than a week or two, or if symptoms are interfering with your daily activities, a physical therapist can help identify the underlying cause and create a personalized plan to promote healing.

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The Takeaway

Achilles tendinopathy doesn’t have to keep you permanently limited. Early intervention, a structured exercise program, and guidance from a physical therapist can help restore your strength, reduce pain, and get you moving confidently again.