Know What Is Achilles Tendinopathy: Symptoms And Recovery Guide

Pain at the back of the ankle is often blamed on a tight calf, overtraining or getting older.

But when the Achilles tendon becomes painful and less tolerant of load, everyday activities such as walking, running and climbing stairs can become uncomfortable.

Achilles tendinopathy is common in runners and active adults, but it can also affect people who do not participate in organised sport.

Treatment usually focuses on understanding the symptoms, adjusting aggravating activities and progressively rebuilding the capacity of the calf-Achilles complex.

What Is Achilles Tendinopathy?

Achilles tendinopathy is a condition involving pain and impaired function of the Achilles tendon.

The Achilles tendon connects the calf muscles to the heel bone.

It helps transfer force from the calf to the foot during walking, running, jumping and pushing off.

The condition is not simply an episode of inflammation.

Tendons can undergo changes in their structure and load tolerance, which is why rehabilitation usually focuses on progressive loading rather than prolonged rest alone.

The 2024 clinical practice guideline for midportion Achilles tendinopathy covers diagnosis, examination, clinical course, risk factors, imaging and physical therapy interventions (Chimenti et al., 2024).

What Are the Two Types of Achilles Tendinopathy?

The location of the pain matters.

Midportion Achilles Tendinopathy

Midportion symptoms are usually felt several centimetres above the heel bone, rather than directly where the tendon attaches.

Pain may appear during running, walking, calf raises or other activities that load the tendon.

Insertional Achilles Tendinopathy

Insertional Achilles tendinopathy affects the lower part of the tendon where it attaches to the heel bone.

This type can behave differently from midportion tendinopathy because the tendon may be sensitive to compression against the heel bone.

That distinction matters during rehabilitation.

A 2025 diagnostic consensus specifically recommends considering symptom location when assessing Achilles tendinopathy and recognizes midportion and insertional conditions as clinically distinct presentations (Malliaras et al., 2025).

What Are the Symptoms of Achilles Tendinopathy?

Common symptoms include:

• Pain at the back of the ankle
• Tenderness along the Achilles tendon
• Morning stiffness
• Pain during or after running
• Pain during calf raises
• Stiffness after sitting or resting
• Reduced tolerance for walking
• Pain when climbing stairs or hills
• Difficulty with jumping or pushing off
• Symptoms that increase after higher tendon loads

The symptoms often change according to the amount and type of activity performed.

Why Does Achilles Tendinopathy Hurt in the Morning?

Morning stiffness is a common symptom.

You may notice pain or stiffness when taking your first few steps after getting out of bed.

It may ease as you begin moving.

Morning stiffness can be useful information when assessing Achilles symptoms, but it does not diagnose tendinopathy by itself.

The overall pattern matters, including where the pain is located, what activities provoke it and how the tendon responds afterwards.

Why Does My Achilles Hurt After Sitting?

The Achilles tendon may feel stiff after a period of inactivity.

Some people notice symptoms when standing up after sitting for a long time, particularly when they have been relatively inactive.

This does not necessarily mean that the tendon has been damaged while sitting.

If the stiffness repeatedly occurs alongside activity-related Achilles pain, reduced calf strength or tenderness over the tendon, an assessment may be useful.

Why Does My Achilles Hurt When I Run?

Running places substantially greater demands on the calf-Achilles complex than ordinary walking.

Symptoms may become more noticeable after changes such as:

• Increasing running distance
• Running faster
• Adding hill sessions
• Sprinting
• Increasing training frequency
• Returning to running after inactivity
• Adding jumping or plyometric exercises

The issue is often not that running is inherently harmful.

The tendon may simply not yet have sufficient capacity for the current training demand.

Can Walking Cause Achilles Tendinopathy?

Walking can aggravate Achilles symptoms, particularly if walking volume has increased or the tendon is already sensitive.

Long walks, hills, stairs or faster walking may increase the workload on the calf-Achilles complex.

However, walking itself is not automatically damaging.

For many people, walking can remain part of rehabilitation if the amount is appropriate for their current capacity.

Why Does My Achilles Hurt When Going Upstairs?

Going upstairs requires repeated calf contraction and greater force production around the ankle.

If the Achilles tendon is sensitive to loading, stairs may provoke pain.

The same can happen when walking uphill because the calf-Achilles complex has to contribute more to forward movement.

Pain on stairs does not necessarily mean that the tendon is worsening.

The response to the overall load and how quickly symptoms settle are more useful when planning rehabilitation.

What Causes Achilles Tendinopathy?

There is rarely one single cause.

Factors that may contribute include:

• Sudden changes in training load
• Repeated running or jumping
• Reduced calf strength or capacity
• Returning to exercise after inactivity
• Increased running speed or hills
• Reduced recovery between demanding sessions
• Previous Achilles symptoms
• Changes in sporting activity
• Individual tendon and lower-limb characteristics

A useful way to understand Achilles tendinopathy is the relationship between tendon capacity and the load being placed on it.

When demand repeatedly exceeds current capacity, symptoms may develop or flare.

Can a Sudden Increase in Exercise Cause Achilles Tendinopathy?

It can contribute.

A person may tolerate their usual running program for months and then develop symptoms after suddenly increasing distance, speed, hills or training frequency.

The same principle applies to people who suddenly start exercising after a long period of inactivity.

This does not mean every increase in activity causes injury.

Tendons normally adapt to loading, but the progression needs to match the person’s current capacity.

Can Tight Calf Muscles Cause Achilles Tendinopathy?

Calf stiffness can influence ankle movement and the demands placed on the calf-Achilles complex.

However, having tight calves does not automatically cause Achilles tendinopathy.

Likewise, Achilles pain does not automatically mean that the calf needs aggressive stretching.

If stretching reproduces tendon pain, repeatedly pushing harder into the stretch may not be helpful.

A physiotherapist can determine whether calf flexibility is actually limiting movement or whether another factor is more relevant.

Can Poor Foot Mechanics Cause Achilles Tendinopathy?

Foot and lower-limb mechanics can influence how forces are distributed through the ankle and Achilles tendon.

However, there is no single foot position that can be blamed for every case.

A physiotherapist may assess:

• Foot movement
• Ankle mobility
• Calf strength
• Balance
• Walking mechanics
• Running mechanics
• Previous injuries

The purpose is not necessarily to “correct” every variation in foot posture.

The important question is whether a particular movement factor is relevant to the individual’s symptoms and functional goals.

Can Shoes Cause Achilles Tendinopathy?

Footwear can alter the position and loading demands placed on the ankle and calf.

A sudden change to very different footwear may therefore change how the Achilles is loaded.

For example, a runner who suddenly changes to footwear with a substantially different heel-to-toe configuration may experience a change in calf-Achilles demand.

This does not mean a particular type of shoe is universally good or bad.

If footwear changes coincide with symptoms, a gradual transition and appropriate training progression may be more useful than simply buying a different shoe.

Can Achilles Tendinopathy Heal on Its Own?

Symptoms can sometimes settle when aggravating loads are reduced.

However, symptom improvement does not necessarily mean that the tendon has regained the strength and load capacity needed for running, jumping or sport.

This is why persistent Achilles tendinopathy is generally managed with progressive rehabilitation rather than waiting indefinitely for symptoms to disappear.

How Is Achilles Tendinopathy Diagnosed?

Achilles tendinopathy is primarily a clinical diagnosis.

A physiotherapist or other healthcare professional may consider:

• The location of pain
• Pain during activity
• Activities that provoke symptoms
• Tenderness when the tendon is examined
• Calf strength
• Functional performance
• The history of symptoms
• Response to loading

A 2025 international Delphi consensus identified pain location, activity-related pain, pain-provoking tests and tendon palpation as essential diagnostic domains.

It also identified several alternative diagnoses that can mimic Achilles tendinopathy (Malliaras et al., 2025).

Do You Need an MRI for Achilles Tendinopathy?

Not usually.

Imaging may be considered when the diagnosis is uncertain, symptoms are unusual, another condition is suspected or the imaging result would change management.

An ultrasound or MRI can provide information about tendon structure, but abnormal tendon structure does not always correspond directly to the amount of pain a person experiences.

The clinical examination remains important.

What Is the Best Treatment for Achilles Tendinopathy?

There is no single treatment that is best for every person.

Current evidence strongly supports exercise-based rehabilitation and progressive tendon loading as central components of conservative management.

A 2026 systematic review found that exercise-based rehabilitation has the strongest evidence among conservative approaches, while supporting a broader progressive loading framework rather than relying on one exercise modality alone (Judd et al., 2026).

What Exercises Help Achilles Tendinopathy?

Exercise selection should depend on the person’s symptoms, tendon location, strength and activity goals.

Common rehabilitation options include:

Isometric Calf Exercises

These involve contracting the calf while holding a position rather than repeatedly moving through the ankle.

They may be useful at certain stages when dynamic loading is difficult.

Calf Raises

Calf raises progressively load the calf-Achilles complex.

They can be progressed by changing:

• Repetitions
• Resistance
• Speed
• Range of motion
• Two-leg to single-leg loading

Bent-Knee Calf Raises

The soleus contributes substantially to plantar-flexion force.

Bent-knee calf raises can therefore complement straight-knee calf raises.

Eccentric Exercises

Eccentric exercises involve controlling the lowering phase of a movement.

They are well studied in Achilles rehabilitation.

However, eccentric exercise should not automatically be described as the only or universally superior treatment.

A 2026 meta-analysis found eccentric exercise improved pain compared with physical modalities but had broadly comparable effects to other exercise approaches (Yuan et al., 2026).

Heavy or Progressive Resistance Exercises

Progressively increasing resistance can help rebuild calf and tendon capacity.

The exact resistance, repetitions and progression should be matched to the individual’s current ability.

Are Eccentric Exercises Best for Achilles Tendinopathy?

Not necessarily.

Eccentric exercises are an important and well-studied option, but current evidence does not support treating them as the only effective exercise approach.

The larger rehabilitation principle is progressive tendon loading.

Exercise can be adjusted according to:

• Pain response
• Strength
• Tendon location
• Current activity level
• Functional goals
• Running or sporting demands

The appropriate program is therefore more important than choosing one exercise simply because it is famous for Achilles tendinopathy.

Is Exercise Safe With Achilles Tendinopathy?

Exercise is generally an important part of rehabilitation, but the amount and type matter.

A tendon that is highly irritable may not tolerate the same loading program as a tendon with mild symptoms.

A physiotherapist may initially modify the activity that causes the largest flare-up and then progressively increase loading as capacity improves.

The goal is not to avoid all discomfort forever. It is to develop a level of loading the tendon can tolerate and progressively increase that capacity.

What About Insertional Achilles Tendinopathy?

Insertional Achilles tendinopathy deserves particular attention because compression at the tendon attachment can be relevant.

Some exercises that take the heel deeply below the level of the forefoot can increase compression at the insertion.

For this reason, exercise selection and range of motion may need to be modified in people with insertional symptoms.

A 2025 randomized clinical trial found that a rehabilitation program designed to reduce tendon compression produced better outcomes than a higher-compression program in people with chronic insertional Achilles tendinopathy (Pringels et al., 2025).

This is one reason why an exercise program for insertional Achilles tendinopathy should not simply copy a midportion Achilles program.

Should You Stop Exercise With Achilles Tendinopathy?

Not necessarily.

Complete rest reduces tendon loading but does not necessarily rebuild the tendon capacity required for future activity.

In many cases, the more useful approach is to modify the aggravating activity and maintain appropriate loading.

For example, a runner may temporarily reduce running volume while continuing appropriately dosed calf strengthening.

The exact modification depends on symptom severity and functional goals.

Can You Run With Achilles Tendinopathy?

Some people can continue running with modifications, while others need a temporary reduction or break.

The decision may depend on:

• Pain during running
• Symptoms later that day
• Morning stiffness the following day
• Calf strength
• Single-leg heel-raise capacity
• Tendon load tolerance
• Running volume
• Running speed
• Stage of rehabilitation

Running should generally be progressed according to how the tendon responds rather than a fixed rule that applies to everyone.

When Can You Return to Running?

Return to running should be progressive.

A rehabilitation pathway may move from:

1. Comfortable everyday walking
2. Brisk walking
3. Short jogging intervals
4. Longer running intervals
5. Increased running volume
6. Faster running
7. Hills, sprinting and sport-specific work

The progression should reflect the person’s actual goals.

A recreational jogger does not necessarily need the same rehabilitation demands as a competitive sprinter.

Why Does Achilles Pain Return After Running?

A common reason is that running capacity has not caught up with the person’s previous training demands.

You may have enough tendon capacity for:

• Normal walking
• Daily activities
• Basic strengthening

but not yet enough capacity for:

• Long-distance running
• Sprinting
• Hills
• Repeated jumping
• High-frequency training

Pain returning after running does not automatically mean that the tendon has been damaged again.

It may indicate that the training progression needs adjustment.

Can Physiotherapy Help Achilles Tendinopathy?

Yes.

Physiotherapy is particularly relevant because exercise progression and functional rehabilitation form a major part of contemporary Achilles tendinopathy management.

A physiotherapist may assess:

• Pain location
• Tendon tenderness
• Calf strength
• Single-leg heel-raise capacity
• Ankle mobility
• Balance
• Walking
• Running mechanics
• Training load
• Previous injuries
• Functional limitations

The aim is to understand what the tendon can tolerate now and what it needs to tolerate in the future.

What Does Physiotherapy Treatment Involve?

Treatment is usually progressive rather than based entirely on passive techniques.

Load Management

The physiotherapist identifies activities that are currently aggravating symptoms and modifies them without unnecessarily eliminating all movement.

Progressive Strengthening

Calf and Achilles loading is gradually increased according to symptoms and capacity.

Movement and Balance Training

Balance and lower-limb control may be addressed when they are relevant to the person’s activities.

Running Rehabilitation

Runners can be progressed through carefully graded running exposure.

Education

Understanding tendon pain, loading and progression can help people make sensible activity decisions between appointments.

The 2024 physical therapy guideline specifically addresses examination and physical therapy interventions for midportion Achilles tendinopathy (Chimenti et al., 2024).

Can Physiotherapy Treat Insertional Achilles Tendinopathy?

Yes, but the rehabilitation strategy may differ from midportion tendinopathy.

The physiotherapist may consider:

• The exact location of pain
• Compression sensitivity
• Calf strength
• Ankle mobility
• Heel-raise tolerance
• Footwear
• Walking and running demands
• Appropriate exercise range

Insertional symptoms may require careful management of exercises that heavily compress the tendon against the heel bone.

This is why a generic Achilles program found online may not be appropriate for everyone.

How Long Does Achilles Tendinopathy Take to Improve?

Recovery varies.

Some people improve over a relatively short period, while persistent symptoms may require a longer rehabilitation program.

Rather than focusing only on the number of weeks, look for functional progress such as:

• Less morning stiffness
• Reduced pain during daily activities
• Improved calf strength
• More comfortable heel raises
• Better walking tolerance
• Improved running tolerance
• Fewer symptom flare-ups
• Ability to handle progressively higher loads

Tendon rehabilitation is about rebuilding capacity, not simply waiting for a calendar date.

Can Achilles Tendinopathy Come Back?

Yes.

Symptoms may return when activity increases faster than the tendon can currently tolerate.

This is particularly common when someone feels better and immediately returns to their previous running or sporting volume.

Continuing appropriate strength work and progressing activity gradually can help maintain tendon capacity.

When Is Achilles Pain Not Typical of Tendinopathy?

Achilles pain should be assessed further if:

• It began suddenly during a forceful movement
• You heard or felt a pop
• You suddenly lost strength
• You cannot push off normally
• There is significant bruising
• There is substantial swelling
• Pain is severe and rapidly worsening
• Symptoms do not behave like an activity-related tendon problem

Other conditions can mimic Achilles tendinopathy, including partial tendon tears, posterior ankle impingement, bursitis, nerve problems and bone stress injuries.

The 2025 diagnostic consensus also identified systemic inflammatory disease, certain metabolic or endocrine conditions and drug reactions as situations that may require medical attention (Malliaras et al., 2025).

What Is the Difference Between Achilles Tendinopathy and an Achilles Rupture?

They are different conditions.

Achilles tendinopathy usually develops with activity-related pain and stiffness.

A rupture can occur suddenly, often during sprinting, jumping or another explosive movement.

A rupture may cause:

• A sudden pop
• Immediate pain
• Sudden weakness
• Difficulty pushing off
• Difficulty walking normally
• Inability or major difficulty performing a heel raise

A suspected rupture requires prompt medical assessment rather than routine self-management for tendinopathy (O’Connor et al., 2023).

Should You Massage an Achilles Tendon?

Massage may feel comfortable for some people, particularly around the calf, but it should not be treated as the primary way to rebuild tendon capacity.

If massage is used, it should complement rather than replace progressive rehabilitation.

Deep pressure directly over a painful tendon may not be appropriate for everyone, particularly when symptoms are highly irritable.

Do You Need Surgery for Achilles Tendinopathy?

Usually, treatment begins conservatively.

Exercise-based rehabilitation is the central component of conservative management.

Surgery may be considered in selected people with persistent symptoms despite an appropriate period of non-operative treatment, but the decision depends on the diagnosis, severity, functional limitations and individual circumstances.

Persistent symptoms do not automatically mean that surgery is required.

Lesser-Known Fact

Achilles pain can improve before the tendon is ready for your previous activity level.

You may feel comfortable walking again while still lacking the strength and load tolerance required for running, jumping or sport.

This is why returning immediately to your previous training volume can cause symptoms to flare again.

The goal of rehabilitation is not simply to make the tendon feel better.

It is to progressively rebuild the capacity required for the activities you want to perform.

When Should You See a Physiotherapist?

Consider a physiotherapy assessment if:

• Achilles pain keeps returning
• Morning stiffness persists
• Running is becoming difficult
• Calf raises are painful or weak
• Walking tolerance has decreased
• You have reduced exercise because of Achilles symptoms
• Symptoms have persisted for several weeks
• You want to return to running or sport
• You are unsure whether your pain is insertional or midportion

A physiotherapist can assess the tendon, calf and lower limb and develop a progressive rehabilitation plan.

When Should You See a Doctor?

Seek prompt medical assessment if you experience:

• Sudden severe Achilles pain
• A popping sensation
• Sudden loss of strength
• Significant bruising or swelling
• Difficulty pushing off
• Inability to walk normally after a sudden injury
• Rapidly worsening symptoms

Medical assessment is also appropriate when symptoms are unexplained, persistent despite appropriate rehabilitation or accompanied by other concerning symptoms.

Conclusion

Achilles tendinopathy can cause pain, stiffness and reduced tolerance for walking, running, stairs and sport.

The most important distinction is where the tendon hurts and how it responds to loading.

Midportion and insertional Achilles tendinopathy can require different rehabilitation considerations.

For most people, treatment centers on progressive tendon and calf loading, appropriate activity modification and gradual return to the activities that matter to them.

Eccentric exercises are one useful option, but they are not the only effective form of rehabilitation.

The program should be adjusted according to tendon location, current capacity, symptoms and functional goals.

Physiotherapy can help assess these factors, guide exercise progression and safely rebuild the capacity needed for everyday activity, running and sport.

The goal is not simply to make Achilles pain disappear.

It is to help the tendon become capable of handling the demands you want to place on it.

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