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What Is Achilles Tendinopathy and What Causes It?

Achilles tendinopathy often causes pain and stiffness at the back of the heel or lower calf, particularly after rest or during activity. This guide explains what the condition is, why it develops, the role of progressive strengthening and when symptoms should be assessed.

Quick Answer

Achilles tendinopathy is a painful condition affecting the tendon that connects the calf muscles to the heel. It commonly develops when the tendon is exposed to more load than it is currently able to tolerate, for example after a change in running, sport or activity. Management usually focuses on gradual strengthening and load management rather than complete rest.

Achilles tendinopathy is a painful condition affecting the Achilles tendon, the strong tendon connecting the calf muscles to the heel.

It commonly develops when the tendon is exposed to more load than it is currently able to tolerate. This may follow a sudden increase in walking, running, sport, hill work or other activity.

What symptoms can Achilles tendinopathy cause?

Pain

Discomfort is usually felt at the back of the heel or slightly higher up the tendon.

Morning stiffness

The tendon may feel stiff or sore on the first few steps after rest.

Activity-related symptoms

Pain may increase with running, jumping, prolonged walking or repeated heel raises.

Tenderness or thickening

The tendon may feel tender or thicker than the opposite side.

What causes Achilles tendinopathy?

There is rarely one single cause. A common trigger is a change in loading: doing more activity, increasing intensity quickly, returning to sport after a break, or repeatedly asking the tendon to work harder than it has adapted to.

Footwear, calf strength, training surfaces, previous injury and general health can also influence symptoms.

Should you completely rest the Achilles?

Usually not for typical gradual-onset tendinopathy. Relative rest and temporarily reducing aggravating activity may help symptoms settle, but progressive strengthening and graded loading are central parts of rehabilitation.

Strengthening matters. NHS physiotherapy guidance describes a progressive calf and Achilles strengthening programme as a key part of recovery, although improvement can take several months.

Can heel lifts or supportive footwear help?

Heel lifts or supportive footwear may reduce symptoms for some people by temporarily reducing strain on the tendon. They are best viewed as symptom-management tools rather than a cure.

How long does recovery take?

Achilles tendinopathy can be slow to settle. NHS guidance notes that rehabilitation may take many months and that temporary flare-ups can occur as activity is progressed.

When should you seek professional advice?

Seek assessment if pain is severe, worsening, repeatedly returning or limiting normal activity, or if symptoms are not improving despite appropriate self-management.

Sudden sharp pain, a snap or pop, difficulty walking or inability to stand on tiptoe can indicate an Achilles rupture. That is different from gradual tendinopathy and needs prompt assessment.

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