Last updated: July 2026
Next review: July 2028

What is it?

The Achilles tendon is a strong band at the back of your ankle. It connects your calf muscles to your heel. It helps you walk, run and stand on your toes.

Achilles tendinopathy happens when the tendon cannot cope with the load placed on it.

You may notice:

• Pain at the back of your ankle
• Stiffness (often worse in the morning)
• Tenderness to touch
• Swelling or thickening

 

Where is the pain?

Mid-portion Achilles pain

• Pain in the middle of the tendon
• A few centimetres above the heel
• Most common type

Insertional Achilles pain (heel)

• Pain at the back of the heel
• Where the tendon attaches to bone

Enthesopathy

• Irritation where tendon meets bone
• Sensitive to pressure
• Sometimes small bone spurs can develop

What causes it?

Often due to too much or too sudden load on the tendon.

Examples include:

• sudden increase in activity
• running, hills or stairs
• being overweight
• some medications
• conditions like diabetes or arthritis
• hormonal changes.

Symptoms

• Pain during or after activity
• Morning stiffness
• Tenderness or swelling
• Reduced calf strength

Pain may ease as you move, then return later.

Managing your Achilles

Stay active

• Keep moving where possible
• Complete rest is not helpful long term
• Modify painful activities

Pain guide

• Some pain is normal.
• Pain should settle with rest.
• Avoid strong or lasting pain.
• Build up slowly.

Exercise

Exercise programme is the main treatment. It helps the tendon become stronger and cope with load. This can take time to improve, and sometimes small adjustments are required if they are challenging.

Helpful tips

• Wear supportive shoes.
• If you have heel pain or a heel bump:

• Some shoes (even trainers) have hard or stiff backs
• This can press on the tendon and increase pain
• Choose shoes with a soft or cushioned heel area.

• A small heel lift may help.
• Use a heel protector if shoes rub:
  • Soft gel sleeve around the heel.
  • Helps reduce pressure and rubbing.

Use the QR code or visit GelX Achilles Heel Protector to see the heel protector product.

• Ice can help short term (wrap in cloth).
• Maintain a healthy weight.
• Manage health conditions blood pressure, diabetes, cholesterol.

Mid-portion Achilles

Responds well to loading exercises.

Approach

• Gradual strengthening
• Progress loading over time

Heel raises

• Start on flat ground
• Progress to a step

Eccentric heel raises 2 up 1 down

• Up on both feet
• Down slowly on painful leg
• Allow heel to go below step

What to expect

• Some discomfort is normal
• Pain should settle after 24 hours
• Small adjustments needed at

See My joint hub Achilles Tendinopathy page for further information.

A video with exercises For Achilles Tendinopathy is also available.

Insertional Achilles (heel)

More sensitive to compression.

What to do

• Heel raises on flat ground
• Slow, controlled movement
• Build gradually

What to avoid (early)

• Heel drops below a step
• Deep calf stretching
• Aggravating shoes or activities

Videos

Top tips for insertional:

Exercises for Insertional:

Other treatment options

Shockwave therapy

• Uses sound waves to target the tendon
• May help reduce pain and support healing
• Used alongside exercise
• Private and self-funded not available in Bristol, North Somerset and South Gloucestershire NHS

Injections

• Not commonly used in the tendon
• Can potential weaken the tendon
• Sometimes used for nearby inflamed bursa

Surgery

• Not commonly needed
• Only for long-term cases
• Surgery at the heel bone for insertional / enthesopathy is invasive and potentially disruptive to the tendon strength / functionality.

Key message

Most people improve with:

• Exercise
• Gradual loading
• Activity changes
• Good footwear
• General health management

More information

NHS Achilles tendinopathy information: