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Condition guide
Achilles tendinopathy
Pain and stiffness at the back of the heel or in the cord above it. Where exactly it hurts matters more than most people realise, because it changes what is likely to help.
What it is
Achilles tendinopathy is pain, stiffness, and degenerative change in the tendon connecting the calf muscles to the heel bone. It is typically an overuse condition that develops gradually, with stiffness that is worst after rest — first thing in the morning or after sitting — and that eases with gentle movement.
It is divided into two forms by location. Midportion tendinopathy affects the tendon a few centimetres above the heel bone. Insertional tendinopathy affects the point where the tendon attaches to the heel itself. The distinction matters because some measures that help one can aggravate the other.
Why the location distinction matters
In insertional cases, movements that bring the ankle into deep dorsiflexion — toes pulled up toward the shin — can compress the tendon against the heel bone and provoke symptoms. That has a direct practical consequence: aggressive stretching off a step, which is a standard suggestion for calf tightness, may be poorly tolerated by someone with insertional pain even though it is often part of management for midportion cases. Similarly, shoes with a stiff heel counter that presses directly on the attachment point are a common aggravator in insertional cases specifically.
This is a good example of why self-directed treatment has limits. The two forms look similar to the person experiencing them, and picking the wrong approach can prolong things.
How it typically presents
- Stiffness and pain at the back of the heel or in the tendon above it, worst after rest
- Eases with light activity, then often worsens again afterwards
- Tenderness when the tendon is squeezed between finger and thumb
- Sometimes a palpable thickening in the tendon
- Frequently follows an increase in training volume, a change in footwear, or a return to activity after a break
What tends to help
Progressive loading exercise is the backbone of management and has the strongest support in clinical guidance. Tendons respond to graduated load rather than to rest, and programmes that build calf loading systematically over weeks are standard. Load management around aggravating activity, footwear changes, and heel lifts to reduce tension on the tendon are common adjuncts.
Complete rest is generally not the goal, and this is one of the conditions where doing nothing tends to work poorly. That said, the specific programme should come from a clinician or physiotherapist rather than from a website, because progression and dosage are the parts that determine whether it works.
- Heel lift height, in millimetres. The specification that defines the product.
- Material density — firmer materials maintain lift under load, softer ones compress.
- Whether the lift is bilateral. Using a lift in only one shoe creates a leg length difference, so products are usually sold and used in pairs.
- Heel counter stiffness in footwear, which is a common aggravator in insertional cases specifically.
| Product | Lift height | Material | Sold as | Sizing range | Weight (per pair) | Returns window |
|---|---|---|---|---|---|---|
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Treat this as urgent
A sudden sharp pain at the back of the ankle, often described as feeling like being kicked or struck, sometimes with an audible snap, and followed by difficulty pushing off or walking, may indicate an Achilles tendon rupture. That requires prompt medical assessment. It is a different problem from tendinopathy and is not something to manage at home.
Common questions
What is the difference between tendinitis and tendinopathy?
Tendinitis implies active inflammation. Tissue studies of long-standing Achilles problems generally show degenerative change rather than classic inflammation, so tendinopathy has become the preferred term. The practical significance is that management centres on progressive loading rather than on anti-inflammatory measures alone.
Should I stretch it?
It depends on which form you have. Calf stretching is often part of management for midportion tendinopathy. For insertional tendinopathy, deep dorsiflexion stretches can compress the tendon against the heel bone and provoke symptoms. This is a case where knowing which form you have genuinely changes the answer, which is a good reason to get it examined.
Do heel lifts help?
Heel lifts reduce tension on the tendon by slightly plantarflexing the foot, and they are commonly used as a short-term adjunct, particularly in insertional cases. They are generally regarded as a symptom-management measure alongside a loading programme rather than a substitute for one. Lifts are used in both shoes to avoid creating a leg length difference.
How long does it take to settle?
Achilles tendinopathy is typically slow to resolve, often taking several months of consistent loading work. Progress is usually gradual and not strictly linear. Consistency with the programme tends to matter more than any product.
Sources
- American Academy of Orthopaedic Surgeons. OrthoInfo — patient education library. [URL NEEDS VERIFICATION]
- NHS. Achilles tendinopathy. [URL NEEDS VERIFICATION]
- Mayo Clinic. Achilles tendinitis. [URL NEEDS VERIFICATION]