Achilles Tendinopathy & Achilles Pain
Achilles tendinopathy is a common cause of pain at the back of the ankle or heel. It can cause pain, stiffness and tenderness in the Achilles tendon, particularly when walking, running, climbing stairs or pushing up onto your toes.
Achilles tendinopathy can develop gradually or follow a change in activity, training or footwear. The way your foot and lower limb move can also influence how load is transferred through the Achilles tendon.
At MK Orthotics in Milton Keynes, we assess the whole lower-limb movement pattern to understand what may be contributing to your symptoms and whether an orthotic intervention is appropriate.
What is the Achilles tendon?
The Achilles tendon is the strong tendon at the back of the ankle that connects the calf muscles to the heel bone.
It plays an important role in walking, running, jumping and pushing up onto your toes. Every step places load through the tendon.
Like other tendons, the Achilles needs to be able to adapt to the amount of load placed upon it. Problems can develop when the tendon is repeatedly exposed to more load than it can currently tolerate.
What is Achilles tendinopathy?
Achilles tendinopathy describes pain and impaired function associated with the Achilles tendon.
You may also hear the term Achilles tendonitis. However, tendinopathy is generally the preferred term because persistent Achilles tendon pain is not simply an inflammation problem.
Achilles tendinopathy can affect active people, runners and sportspeople, but it can also affect people who do not participate in sport.
Where does Achilles tendinopathy cause pain?
There are two main locations where Achilles tendinopathy occurs:
Mid-portion Achilles tendinopathy
This affects the middle part of the Achilles tendon, usually around 2–6 cm above where it attaches to the heel bone.
Pain is usually felt at the back of the ankle or lower calf and may be accompanied by tenderness or thickening of the tendon.
Insertional Achilles tendinopathy
This affects the lower part of the tendon where it attaches to the heel bone.
Pain is usually felt directly at the back of the heel and may be aggravated by pressure from footwear or activities that increase compression around the tendon insertion.
These two types can behave differently, which is one reason why understanding exactly where your pain is coming from is important.
What does Achilles tendinopathy feel like?
Symptoms vary between people, but common symptoms include:
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Pain or aching at the back of the ankle or heel
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Stiffness when you first get up in the morning
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Stiffness after sitting or resting
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Tenderness when the tendon is touched
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Pain when walking uphill or upstairs
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Pain when pushing up onto your toes
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Pain during or after running or exercise
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Swelling or thickening around the tendon
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A painful area or lump that may rub against footwear
Some people find that the pain eases once they get moving but becomes more noticeable afterwards. Others experience pain throughout activity.
The pattern of symptoms and how they respond to loading can provide useful information when assessing the problem.
What causes Achilles tendinopathy?
There is rarely one single cause.
Achilles tendinopathy can occur when the tendon is unable to adapt to the amount of load being placed upon it. This may happen following a sudden increase or change in activity, but it can also develop gradually.
Potential contributing factors include:
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A sudden increase in running or walking
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Changes in training intensity, distance or terrain
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Increased hill running
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Returning to exercise after a period of reduced activity
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Changes in footwear
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Reduced calf strength or capacity
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Restricted ankle movement
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Foot posture and lower-limb mechanics
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Repetitive loading through the tendon
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Certain medical conditions or medications
Risk factors can vary considerably between individuals, so identifying what has changed around the time your symptoms developed can be particularly useful.
Can foot mechanics contribute to Achilles tendinopathy?
They can be a contributing factor in some people, but there isn’t one particular foot type that causes Achilles tendinopathy.
The position and movement of the foot can influence how forces are transferred through the ankle and Achilles tendon.
For example, people with very high or low arches may have different loading patterns through the lower limb. Both high and low foot arches can be associated with Achilles tendinopathy.
However, foot posture is only one part of the picture.
We also consider:
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Ankle range of movement
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Foot movement during walking
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Calf strength and endurance
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Lower-limb alignment
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Hip and knee control
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Running or walking mechanics
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Training load
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Footwear
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Previous injuries
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The location and behaviour of your symptoms
The aim is to understand how your individual mechanics relate to your symptoms rather than assuming that your foot shape is the cause.
Can tight calves cause Achilles pain?
Calf muscle function and Achilles tendon loading are closely related because the calf muscles connect to the Achilles tendon.
Reduced calf capacity, changes in ankle movement or a sudden increase in the amount of work required from the calf-Achilles complex may contribute to symptoms.
However, simply stretching a “tight” calf is not necessarily the answer.
The appropriate approach depends on why the tendon is painful, how much load it can currently tolerate and how your symptoms respond to activity.
Can Orthotics help Achilles tendinopathy?
Sometimes, but an orthotic is not automatically required.
If your assessment identifies a foot or lower-limb loading pattern that may be contributing to the stress placed on the Achilles tendon, an orthotic may form part of a wider management strategy.
An orthotic may be designed to influence how load is distributed through the foot and lower limb.
In some situations, a temporary heel lift or change in footwear may also reduce the amount of strain placed on the Achilles and make activity more comfortable. NHS guidance recognise inserts, heel lifts or orthotics as possible measures in appropriate cases.
However, orthotics do not replace appropriate tendon rehabilitation.
Achilles tendinopathy commonly requires a gradual, progressive approach to loading and strengthening. NHS physiotherapy guidance emphasise exercise and progressive rehabilitation as important parts of recovery.
Our role is therefore to establish whether an orthotic intervention is likely to be useful for your particular mechanics and symptoms.
What happens during an MK Orthotics assessment?
At MK Orthotics, we don’t prescribe orthotics simply because you have been diagnosed with Achilles tendinopathy.
We first look at the relationship between your symptoms, foot mechanics and lower-limb function.
Your approximately 90-minute assessment may include:
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Detailed discussion of your symptoms
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Review of your activity and training
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Assessment of foot posture
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Assessment of ankle and foot movement
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Calf strength and function
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Lower-limb alignment
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Functional movement assessment
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Assessment of walking and running mechanics
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Video gait analysis where appropriate
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Review of your footwear
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Assessment of any existing orthotics or insoles
We then consider whether an orthotic intervention could reasonably contribute to your management.
If we don’t think orthotics are appropriate, we will tell you.
What if I’ve already tried orthotics?
If you’ve already tried orthotics or insoles and your Achilles pain has continued, it is useful to understand what the previous device was designed to do.
Bring your previous orthotics with you if possible.
We can consider:
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What the orthotic was designed to change
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Whether it altered your loading pattern
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Whether it was comfortable
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What footwear you used with it
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Whether your symptoms changed
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Whether your original assessment identified the relevant contributing factors
A previous unsuccessful orthotic does not necessarily mean that an orthotic can never be useful, but it is important to understand why the previous approach didn’t work before trying something else.
What else can help Achilles tendinopathy?
Achilles tendinopathy usually needs to be managed as a load-related tendon problem, rather than simply resting until the pain disappears.
Management may include:
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Appropriate modification of aggravating activities
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Gradual tendon loading and strengthening
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Review of running or training volume
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Appropriate footwear
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Temporary use of a heel lift or other intervention where appropriate
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Addressing relevant strength or movement deficits
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Orthotic intervention where indicated
Recovery can take time. Achilles tendons can remain sensitive for several months, and returning to activity too quickly can aggravate symptoms.
A physiotherapist or other appropriate healthcare professional can guide tendon rehabilitation where required.
Can I keep running with Achilles tendinopathy?
Whether you can continue running depends on the severity of your symptoms and how the tendon responds to loading.
Complete rest is not necessarily required for every person, but continuing with an activity that significantly aggravates your symptoms may make rehabilitation more difficult.
A gradual return to running should be based on your symptoms, tendon capacity and ability to tolerate progressively increased loading. A gradual return to sport is recommended to avoid repeatedly aggravating the tendon.
If you have significant pain, swelling or a sudden change in symptoms, seek appropriate clinical assessment rather than trying to run through it.
When should Achilles pain be assessed?
Consider having your Achilles pain assessed if:
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It has persisted despite reducing aggravating activity
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It is affecting your walking or exercise
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Pain keeps returning when you increase activity
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You have morning stiffness or persistent tenderness
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You have noticed swelling or thickening of the tendon
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You have already tried insoles or orthotics without success
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You are unsure whether the pain is actually coming from the Achilles tendon
You should seek urgent medical assessment if you experience sudden severe pain at the back of the ankle, a popping or snapping sensation, significant difficulty walking or difficulty pushing up onto your toes, as these can be features of an Achilles tendon rupture or another significant injury.
Achilles tendinopathy and foot pain
If you have persistent Achilles pain, stiffness or tenderness and want to understand whether your foot and lower-limb mechanics could be contributing, MK Orthotics can assess you in Milton Keynes.
Our approach is not simply to prescribe an orthotic because you have Achilles tendinopathy.
We assess the whole movement pattern and consider whether an orthotic could form a useful part of your management alongside appropriate rehabilitation and load management.
Related conditions
Achilles pain can overlap with other foot and lower-limb problems.
You may also find these pages useful:
Achilles pain causing you problems?
If Achilles pain is affecting your walking, running, exercise or everyday activities, an assessment can help identify the factors that may be contributing.
Book a 90-minute biomechanical assessment with MK Orthotics in Milton Keynes.
MK Orthotics is based in Blakelands, Milton Keynes.