By the KMW Podiatry team. Last reviewed November 2026.
The Achilles tendon is the thick cord at the back of your ankle that connects your calf muscles to your heel bone. It works hard every time you walk, run, jump or climb stairs. When it becomes painful and stiff, it can make everyday activities difficult and put a stop to running. Achilles tendinopathy is a common cause of this pain. This guide explains what it is and how it is usually managed.
What is Achilles tendinopathy?
Tendinopathy is a general term for pain and changes in a tendon, often linked to the load placed on it. You may also hear it called Achilles tendonitis, although inflammation is not usually the main issue in long-standing cases. Healthdirect notes that tendinopathy is caused by stress on a tendon, such as repeated or sudden movements, and can lead to pain, swelling and difficulty moving the affected joint.
There are two main types:
- Mid-portion Achilles tendinopathy, felt a few centimetres above the heel, sometimes with a thickened or tender lump in the tendon.
- Insertional Achilles tendinopathy, felt where the tendon attaches to the back of the heel bone.
The distinction matters because the two types can respond differently to some exercises and footwear changes.
Common symptoms
- pain and stiffness at the back of the ankle or heel, often worst first thing in the morning
- pain at the start of exercise that may ease as you warm up, then return afterwards or the next day
- tenderness when you squeeze the tendon
- thickening or swelling of the tendon
- pain when going up stairs, hopping or rising onto your toes
Why does it happen?
Achilles tendinopathy often develops when the load on the tendon increases faster than it can adapt. Common factors include:
- a sudden increase in running distance, speed or hill work
- returning to sport after a break
- new or different footwear, or a change to harder surfaces
- reduced calf strength or endurance
- being in middle age, when tendons may adapt more slowly
- some medical conditions and medicines, which your GP or podiatrist can discuss with you
When to seek urgent care
If you feel a sudden snap or a sensation of being kicked in the back of the leg, followed by difficulty walking or rising onto your toes, you may have ruptured the tendon. This needs prompt medical assessment, so see your GP or go to an emergency department.
How is Achilles tendinopathy managed?
Management usually focuses on reducing pain enough to stay active, then gradually building the tendon’s capacity to cope with load. Most people are managed without surgery.
Load management
Rather than stopping all activity, the aim is usually to reduce aggravating activities to a level the tendon tolerates. A common guide is that some mild discomfort during exercise may be acceptable if it settles within 24 hours and does not get progressively worse. Your podiatrist can help you set appropriate limits.
Strengthening (loading) exercises
Progressive calf and tendon strengthening exercises are a core part of management and are supported by research. These usually start with simple exercises such as calf raises and are gradually progressed over weeks to months. Programs differ for mid-portion and insertional tendinopathy. See our strengthening exercises for the foot and ankle.
Tendons adapt slowly, so it is common for improvement to take several months. Sticking with the program matters.
Footwear and heel lifts
Shoes with a slightly raised heel, or a temporary heel lift, may reduce strain on the tendon for some people, particularly with insertional pain. Shoes with a firm or rubbing heel tab can irritate the back of the heel.
Gait and running review
Looking at your training load, running technique and footwear can help identify factors that may be contributing. See sports podiatry.
Shockwave therapy
Extracorporeal shockwave therapy may be considered for some people with persistent tendinopathy that has not improved enough with an exercise program. Research results are mixed, and it is usually used alongside exercise, not instead of it. Learn more about shockwave therapy for tendon pain.
Other options
Some people are referred to their GP or a sports physician for further assessment, imaging or other treatment if symptoms persist despite a well-structured program.
Returning to running
A gradual return is usually recommended, building up distance before speed and hills. Many people use a simple walk-run program and monitor how the tendon feels the next morning. Flare-ups can happen; they are usually a sign to ease back a little rather than stop completely.
Frequently asked questions
Should I stop running with Achilles pain?
Not always. Many people can keep running at a reduced level if pain is mild and settles within 24 hours. If pain is severe, getting worse or affecting walking, rest from running and get assessed.
How long does Achilles tendinopathy take to get better?
It varies. Tendons adapt slowly, and improvement often takes weeks to months of consistent exercise. Long-standing cases can take longer.
Is stretching enough for Achilles pain?
Stretching alone is not usually enough. Progressive strengthening exercises are the main focus of most management plans. Some stretches can aggravate insertional tendinopathy, so check with your podiatrist.
Do I need a scan?
Many people do not need a scan to start management. Your podiatrist or GP may suggest imaging if the diagnosis is unclear, symptoms are not improving, or a tear is suspected.
Book an Achilles assessment
If Achilles pain is affecting your walking, work or sport, a podiatrist can assess the tendon, your footwear and your training, and help you plan a gradual program. Read more about Achilles tendon injuries or book an appointment online. You can also call 1800 962 113.
This article is general information only and is not medical advice. Please see your GP or podiatrist about your own situation. KMW Podiatry’s podiatrists are registered with the Podiatry Board of Australia through Ahpra.
