The Achilles tendon plays a pivotal role in almost every lower-limb movement. As the strongest tendon in the human body, it connects the calf muscles to the heel bone and allows the foot to push off the ground with power and precision. Yet, despite its strength, the Achilles tendon is also one of the most frequently injured structures.
High daily loads, repetitive strain, and sudden bursts of activity make it particularly vulnerable, especially for walkers, runners, and people with demanding occupational or sporting routines.
Achilles pain is not a single condition. Instead, it represents a spectrum of possible injuries — from chronic degenerative changes to acute ruptures. Each type of Achilles issue behaves differently and requires a tailored treatment strategy.
Foot Foundation provides detailed assessment, diagnosis, and advanced podiatric treatment to ensure every patient receives the correct pathway for recovery.
Why Achilles Pain Happens
The Achilles tendon endures forces up to six times body weight during running. Over time, or under excessive strain, this can lead to tissue breakdown, irritation, inflammation, or in severe cases, tearing.
Several factors increase the likelihood of developing Achilles pain:
Rapid increases in training load
Poor footwear or worn-out shoes
Flat feet or high-arched feet
Calf muscle tightness or weakness
Hard or uneven training surfaces
Previous lower-limb injuries
Age-related tendon changes
These factors place abnormal stress on the tendon, prompting a cascade of micro-damage that can progress into a persistent problem if not managed early.
Common Types of Achilles Pain
Achilles Tendinopathy (Mid-portion)
This is the most widespread form of Achilles injury, occurring 2–6 cm above the heel. Unlike an acute sprain, mid-portion tendinopathy is a degenerative condition rather than an inflammatory one.
Patients commonly describe:A dull or burning ache during activity
Morning stiffness that eases after movement
Thickening or nodules along the tendon
Pain that flares with running or prolonged walking
If unmanaged, the tendon becomes less elastic, making it more susceptible to future injury.
Insertional Achilles Tendinopathy
This condition affects the point where the tendon attaches to the heel bone. It is often aggravated by compression — especially when walking uphill or wearing shoes with rigid heel counters.
Typical symptoms include:Localised pain at the tendon’s attachment
Swelling or thickening at the back of the heel
Discomfort during stair climbing or sprinting
Pain during the first steps of the day
Insertional tendinopathy requires a different rehabilitation approach than mid-portion tendinopathy, particularly avoiding deep stretching that may worsen symptoms.
The retrocalcaneal bursa is a small protective cushion between the tendon and heel bone. When irritated, it becomes swollen and inflamed, causing:
Sharp, pinching pain behind the heel
Noticeable swelling
Pain when wearing tight shoes
Discomfort during walking or running
This condition can occur alone or alongside insertional Achilles tendinopathy.
A rupture is a dramatic, sudden injury involving partial or complete tearing of the tendon. It often happens during explosive activity such as sprinting, basketball, or football.
Symptoms typically include:A sudden “snap” or “pop”
Feeling like someone kicked or hit the back of the leg
Immediate weakness and difficulty pushing off
Rapid swelling and pain
A rupture requires urgent assessment, as prompt management significantly improves long-term outcomes.
Key Symptoms That Should Not Be Ignored
While not every ache is a serious injury, certain symptoms warrant prompt assessment by a podiatrist:
Pain that worsens over weeks
Stiffness in the morning or after inactivity
Visible swelling or thickening
Difficulty walking uphill or climbing stairs
Pain that improves with rest but returns quickly
Sudden sharp pain or a popping sensation
Early intervention often prevents small issues from escalating into long-term tendon degeneration.
How Foot Foundation Assesses Achilles Pain
Accurate diagnosis is essential for effective treatment. Foot Foundation uses a detailed, multi-layered assessment process tailored to the specific nature of Achilles injuries.
Biomechanical Assessment
Clinicians examine foot alignment, calf strength, ankle mobility, and load distribution to determine how the lower limb contributes to tendon stress.
Walking and running patterns are analysed to understand how movement mechanics may be overloading the tendon.
Ultrasound or Imaging Referral (if required)
For complex or long-standing cases, imaging helps assess tendon structure, inflammation, or partial tearing.
Functional Strength Testing
Calf endurance, tendon elasticity, and load tolerance are evaluated to guide treatment progression.
This thorough assessment allows clinicians to create a tailored rehabilitation plan rather than relying on generic protocols.
Evidence-Based Treatment at Foot Foundation
Achilles injuries respond best to structured, progressive, and scientifically informed care. Treatment may include:
Delivers targeted acoustic energy to stimulate tendon healing, reduce chronic pain, and promote new collagen formation.
Orthotics redistribute force, support proper foot mechanics, and reduce strain on the Achilles during daily activity and sport.
A personalised strengthening programme — usually involving controlled loading — helps the tendon rebuild its structure and resilience.
This may include:
Eccentric loading exercises
Isometric protocols for pain relief
Calf strength and endurance training
Return-to-sport progressions
Soft tissue techniques and joint mobilisation can improve mobility and reduce compensatory strain on the tendon.
Clinicians guide patients on load management, running technique, and selecting footwear that minimises tendon stress.
Rupture Rehabilitation or Referral
For Achilles ruptures, Foot Foundation provides assessment, conservative management, and coordination with orthopaedic specialists where necessary.
Preventing Achilles Pain
Although not all injuries are avoidable, several strategies significantly reduce risk:
Gradually increase training volume
Wear supportive, well-fitted footwear
Strengthen the calves and surrounding musculature
Avoid sudden changes in running surfaces or intensity
Warm up properly before activity
Listen to early warning signs such as stiffness or persistent aches
Prevention is especially valuable for runners, athletes, and individuals on their feet all day.
