Achilles Tendinopathy
What is effective for Achilles tendinopathy… from an Achilles tendon specialist
Achilles tendinopathy is a common Achilles tendon injury, affecting the tendon in two areas: the mid-portion (the most common) and the insertion to the heel bone. Mid-portion Achilles tendinopathy typically affects middle-aged distance runners, though it affects many other sports. In most cases, patients respond to exercise therapy and a progressive return to sport.
Dr Masci treats Achilles tendinopathy at his London clinics as a tendon specialist and has published the management principles for this condition. This guide is the clinical overview; for runner-specific advice, exercises, and the full list of causes, see the linked guides below.
What is Achilles tendinopathy?
The Achilles tendon transmits the force of the calf muscles to the heel. Overload causes collagen to break down and the tendon to thicken and swell, resulting in pain and reduced function. Two patterns exist: mid-portion Achilles tendinopathy (2–6 cm above the heel) and insertional tendinopathy (at the heel bone itself), which is often associated with bone spurs and heel bursitis.
How is Achilles tendinopathy diagnosed?
People report pain in the Achilles tendon during and after activity, with characteristic morning stiffness. We always look for the cause — a sudden rise in training load, calf weakness, or contributing conditions such as diabetes and high cholesterol. A biomechanical review identifies what needs to be corrected, such as calf weakness.
We confirm the diagnosis and exclude mimics with imaging — Achilles paratenonitis, a tear, posterior ankle impingement, and calcaneal stress fracture. Ultrasound shows thickening and collagen breakdown, is cheaper than MRI, and can be performed during the consultation. For the full list of conditions that mimic it, see our guide to Achilles tendon pain after running.
How do we treat mid-portion Achilles tendinopathy?
Exercise is the foundation.
Progressive calf strengthening — weighted calf raises tailored to you, ideally under physiotherapist supervision — is the core treatment. Our guide for runners covers the full exercise progression and strength goals.
Treatments that support exercise
GTN patches reduce pain and improve exercise response. Shockwave therapy works best combined with calf strengthening. And occasionally injections help — Dr Masci co-authored the review of ultrasound-guided injections for tendinopathy — though cortisone is avoided in this large weight-bearing tendon.
When the plantaris is involved
In a small number of cases, a thickened plantaris tendon rubs against the Achilles and stalls rehabilitation. Dr Masci’s research shows these cases may need a modified exercise programme, a hyaluronic acid injection, or early surgery.
Surgery
Generally, we reserve surgery for the few who fail everything else. Most patients recover without it.
Frequently asked questions about Achilles tendinopathy
What’s the difference between mid-portion and insertional Achilles tendinopathy?
Mid-portion tendinopathy sits 2–6 cm above the heel; insertional tendinopathy is at the heel bone, often with bone spurs and bursitis. Insertional cases need a modified exercise programme that avoids deep ankle dorsiflexion.
How long does Achilles tendinopathy take to heal?
Months of consistent rehab — often 3–6, sometimes longer. A study found nearly 1 in 5 people still had symptoms at 10 years, but structured exercise greatly improves the odds of becoming pain-free.
Should I rest completely?
No. The tendon needs progressive load, not rest. Reduce aggravating activity, but keep strengthening — complete rest weakens the tendon and slows recovery.
Final word from Sport Doctor London about Achilles tendinopathy
Achilles tendinopathy is common in middle-aged runners but extends across sports. Warm-up pain at the tendon is typical. Treatment is built on calf strengthening, supported by GTN patches, shockwave, or — occasionally — injections, with surgery reserved for failures.
To book a one-stop Achilles assessment with Dr Masci in London, contact his team here or call +44 (0) 203 488 0350.