Active Podiatry - Sports Podiatry for Runners & Athletes

Achilles Tendinopathy

Achilles Tendon PainAchilles Tendinopathy is one of the most common running sports injuries. The Achilles tendon is the longest tendon in the body and attaches the calf muscle to the foot. It is very active in runners as it helps with stability and propulsion.

How does the tendon get injured?

The injury occurs when the breakdown of strengthening collagen fibres in the tendon occurs at a greater rate than the body's ability to regenerate. This happens where there is repetitive loading and stress on the tendon over time due to factors such as overtraining, a change in running style without sufficient adaptation over time, and faulty biomechanics where there is an abnormal load on the tendon.

How do I know if I've got it?

The signs and symptoms of Achilles Tendinopathy are pain, swelling and stiffness in the Achilles Tendon, usually at about the mid section of the tendon. Pain and stiffness can be felt first thing in the morning as well as during exercise, but generally hurts up to 24 to 48 hours after loading.

How is it treated?

Achilles Tendinopathies can take a long time to heal with 6 months to full recovery being common, so the earlier treatment is started the better!

In the very early stages rest from exercise and normal non prescription pain relief such as Ibuprofen can help to ease symptoms. However tendons don’t like to be rested for too long so early mobilisation in a controlled way is key in the first stages of rehabilitation.

High impact exercise such as running and jumping should be avoided if tendon pain is more than 4/10 on a scale of 1 to 10 in a 24 to 48 hour period after exercise. At this stage a programme of low impact cross training such as cycling, swimming or pool running is important to maintain aerobic fitness and mobilise the tendon without overloading it.

The secret to quicker recovery with Achilles Tendon problems is managing load through the tendon, making sure the tendon is not ‘overloaded’ or ‘underloaded’. This can be tricky to get right so in most cases some professional help will be needed to properly manage the injury and speed up the healing process.

How can a Podiatrist help?

A typical Sports Podiatry management plan will usually consist of the following:

  • Controlled loading exercises under supervision to strengthen and rehabilitate the tendon. These are often called 'Heel Drops' and are a very effective, evidence based treatment if properly managed and supervised.
  • A course of clinic therapy sessions including massage, dry needling, ultrasound, joint mobilisations and sports taping as necessary to speed up and optimise recovery of the tendon and relieve pain.
  • Identification and treatment of any biomechanical abnormalities such as excessive pronation which may be contributing to abnormal loading of the tendon. This may require corrective measures such as modification of sports footwear and prescription of orthoses.


Achilles Tendinopathy is a frustrating injury which can take time to heal but a structured programme of relative rest from impact exercise, cross training and physical therapy carried out in a timely and progressive fashion wins the day.

Finally remember that prevention is better than cure so warm ups before exercise, warm downs and stretching after exercise, and avoiding overtraining, or 'too much too soon', will all help to reduce the risks of this frustrating injury from occurring in the first place.

Please note that the content in this blog is for information only and should not be followed or used as a treatment plan without consulting a qualified health professional first. All Podiatrists are registered with the Health and Care Professions Council and can be consulted directly without first seeing a doctor.

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Tim Veysey-Smith Cross Country RunningI produce these blogs for the benefit of the running community and I want as many runners as possible to benefit from these. It would really help me if you could take a moment to share these articles with your friends on social media and any relevant groups or forums that you may be subscribed to.

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