Achilles Tendinopathy

(tendon pain at the back of the ankle/heel)

Information and Exercise Leaflet for

Patients and Carers

What is Achilles Tendinopathy?

Tendinopathy is a condition that involves pain and reduced strength in a tendon. It may result from a change in activity levels. It may involve you doing more activity than previously, however it can also be a result of doing less than you would normally for example, after a period of illness or extended rest.

If you have an Achilles Tendinopathy you will feel pain at the back of your ankle/heel in the tendon that runs from the calf which attaches into the back of your heel.

The result is that the reduced strength in your tendon means the activities you do now are too much for you to tolerate. Therefore, you get pain. 

Common features

Most people will experience pain after rest and first thing in the morning.

It is not uncommon to develop a lump on your Achilles tendon. This is part of the healing process and may also be due to swelling.

Full recovery can take between 3 and 12 months when following the correct advice and rehabilitation programme.

Should I be resting or moving?

You are safe and generally better off if you move. There is no evidence to suggest remaining active will place your tendon at greater risk of damage.

If you keep still and significantly reduce your activity levels, your tendon strength may further reduce.  This could lead to further pain and reduced function.

Activity Diary and Modifications

It is sometimes useful to make a note of the daily activities that aggravate your symptoms.  Below are some of the main aggravators and some modifications you can make to help reduce the painful reaction.

How do I know if I am doing too much?

It is common to get a painful reaction if too much load is put through the tendon.  If this pain is more than 5/10 (with 10 being the worst pain imaginable) and lasts for more than 24 hours, check what you have been doing and ease back, but you do not need to completely stop the activity/exercise.

Once this has settled you can start to gradually introduce your activities and exercises again.  If you have an acceptable discomfort (pain is less than 5/10) and this settles within 24 hours, then keep going with your exercises and gradual return to full activities (see below).                    

Pain relief and injections

Painkillers can help you to keep moving, however, it is important to discuss this with your GP, especially if you are taking any other medication(s).

Injections are not recommended for this problem.

What about sports and work?

You should use the previously mentioned reaction rules to determine whether return/adaptation to sport and work is advisable at this stage.                                   

Do I need any tests?

Achilles Tendinopathy is diagnosed clinically. In most cases this can be diagnosed through discussion of your symptoms with a clinician. Scans and other investigations are often not recommended as they are not required.

What are the aims of physiotherapy?

The aims of physiotherapy are to increase muscle strength, the amount of activity you can tolerate and reduce the pain in your tendon. This should allow you to return to your previous activities.

General measures to help

 Weight control

If you are overweight, try to lose some weight as the extra burden placed on your tendon can make symptoms worse.  Even a modest weight loss can make a significant difference.

Poor diet, high cholesterol and diabetes can make you more likely to develop Achilles Tendinopathy.

Warning signs

If you develop new or worsening symptoms, if you are unwell with the pain, or under the age of 16 years, seek medical advice.

The following symptoms are very rare, but if you develop any of them, you should seek urgent medical attention at your local Urgent Care Centre.

• Sudden onset of Achilles pain, with a “pop” or snapping sound/sensation.
• Inability to weight-bear through the foot/ankle.
• New significant injury to the leg/foot/ankle.
• Constant night pain in the foot/ankle (that prevents rest/sleep).
• Significant swelling, colour change or temperature change in the foot/ankle or extending up the leg.
• Lumps in the foot/ankle.
• Signs of infection i.e. night sweats that are out of the ordinary, high temperature and feeling unwell.
• Unexplained weight loss

If your symptoms fail to improve within 6-8 weeks with this regime you should contact your doctor for a physiotherapy referral.

If your symptoms are improving (even slowly), continue for up to 3 months.

Exercises for Achilles Tendinopathy

The exercises below are in order of difficulty. Start with the first and if this does not increase your symptoms progress to the next one.

Use the reaction rules to guide your exercise intensity. If pain is stopping you engaging in rehab, you should speak to your GP about pain relief promptly. 

Flare-ups may happen - if it doesn't settle in a couple of weeks, then seek further advice.