Achilles Tendinopathy: Causes, Symptoms & How to Recover

Achilles tendinopathy is an overuse injury of the Achilles tendon which is the thick band of tissue connecting your calf muscles to your heel bone. It causes pain, stiffness and sometimes swelling at the back of the ankle. It's one of the most common reasons runners, walkers and weekend athletes end up avoiding the exercise they love.

If your heel is niggling every time you get out of bed or push off during a run, here's what's likely happening, and what actually helps.

What Is Achilles Tendinopathy?

Your Achilles tendon copes with huge load every day — up to 6–8 times your body weight when you run. Tendinopathy develops when the tendon is loaded faster than it can adapt, causing the tendon fibres to become disorganised and the area to thicken. It's not the same as a tear or rupture, and in most cases it responds very well to the right kind of loading and rehab.

There are two common types:

• Mid-portion tendinopathy : pain 2–6cm above the heel, the most common form

• Insertional tendinopathy : pain right where the tendon attaches to the heel bone

What Causes It?

• A sudden increase in running volume, hill work, or intensity

• Returning to activity too quickly after time off

• Tight or weak calf muscles

• Poor footwear or a recent change in shoes

• Training on hard or uneven surfaces

• Age-related changes in tendon structure (mid-30s onward is a common window)

Common Symptoms

• Pain and stiffness at the back of the heel, often worst first thing in the morning

• Pain that eases as you warm up, then returns after activity

• Tenderness when you squeeze the tendon

• A thickened or "lumpy" feeling along the tendon

• Discomfort going up stairs or up on your toes

What to Do About It

Don't fully rest. Complete rest often makes tendinopathy worse in the long run, tendons need controlled load to remodel and strengthen. The goal is modifying load, not eliminating it.

Start isometric and strengthening exercises. Calf raises (both straight and bent-knee), done progressively, are one of the most evidence-backed treatments for Achilles tendinopathy. A physio can build a program that matches your specific stage of injury.

Address contributing factors. Footwear, training load, calf and ankle strength, and running technique often need to be looked at together, not just the sore spot itself.

Give it time. Tendinopathy is a slow-healing condition. Most people see meaningful improvement over 6–12 weeks of consistent, well-dosed rehabilitation, some cases take longer.

When to See a Physio or Podiatrist

If heel pain has hung around for more than a week or two, or keeps returning every time you try to get back into exercise, it's worth getting assessed properly. A physio or podiatrist can confirm what's actually going on (tendinopathy vs. a tear vs. something else entirely, like retrocalcaneal bursitis) and build a loading program specific to your tendon, your sport and your goals.

Our physiotherapists & podiatrists across VIC, NSW and SA see Achilles and heel pain regularly — book an appointment and let's get you back to running without dreading the first few steps.