Achilles tendinopathy: understanding your ankle pain and getting back to activity

What is Achilles tendinopathy?

The anatomy of the Achilles tendon

The Achilles tendon is the strongest tendon in the human body. It connects the calf muscles (gastrocnemius and soleus) to the heel (calcaneus) and drives propulsion with every step, stride and jump. Mid-portion tendinopathy is distinguished from insertional tendinopathy, closer to the heel, which is managed slightly differently.

Why does this tendon become painful?

Pain appears when the Achilles tendon is repeatedly loaded beyond its capacity to adapt, particularly during running and jumping activities. A training volume increased too quickly, a stiff calf, or a change of terrain or shoes are the most common causes of tendon overload.

Symptoms and diagnosis of Achilles tendinopathy

Typical pain and its triggers

The pain is located on the Achilles tendon, often accompanied by noticeable morning stiffness that eases after a few minutes of walking. It’s triggered or worsened by running, especially uphill or downhill, and by climbing stairs. A localised thickening of the tendon may be palpable, sometimes with tenderness to touch.

Differential diagnosis

Several types of ankle and calf pain can look like Achilles tendinopathy:

• Sever’s disease, which mainly affects growing adolescents at the heel
• Calf muscle strain, with pain higher up, in the muscle belly
• Plantar fasciitis, with pain under the heel rather than on the tendon

Causes and risk factors

Achilles tendinopathy develops when load accumulates faster than the tendon can absorb it.

Biomechanical and personal factors

• A too-rapid increase in training volume or intensity
• A stiff calf or limited ankle dorsiflexion mobility
• A recent change of terrain, footwear or running style
• A strength imbalance between the two legs

Which sports contribute to Achilles tendinopathy?

All sports involving repeated impact and propulsion place particular strain on this tendon:

• Running, especially on hard surfaces or uphill
• Football and basketball (jumping, sprinting)
• Tennis and racquet sports
• Hiking and trail running
• Dance
• Volleyball

Treating Achilles tendinopathy in rehab with a sports physio

The goal of treatment is to progressively strengthen the Achilles tendon to restore its capacity to absorb load, particularly through eccentric training, which is well documented scientifically for this condition.

1. 1Reducing pain and managing load
2. 2Ankle mobility
3. 3Isometric strengthening
4. 4Progressive concentric strengthening
5. 5Eccentric strengthening
6. 6Ankle proprioceptive work
7. 7Correcting movement and footing
8. 8Strengthening under sport-specific load
9. 9Progressive return to running
10. 10Return to competition

“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”

Eccentric strengthening, the cornerstone of treatment

Eccentric calf strengthening, particularly slow single-leg heel drops, is the most scientifically documented protocol for Achilles tendinopathy. It’s complemented by broader work on the posterior chain and ankle stability.

In brief

• Eccentric calf strengthening
• Broader work on the posterior chain
• Progressive correction of running load
• Gradual return: mobility, then load, then sport

Should you rest or keep playing sport?

Complete rest generally isn’t necessary and isn’t the most effective solution. It’s better to temporarily adjust the running or jumping volume that clearly reproduces the pain, while starting eccentric strengthening as soon as possible.

When should you see a specialist for Achilles tendinopathy?

If the pain persists for more than four to six weeks despite adjusting your activities and following a well-run strengthening programme, or if you feel a “snap” suggestive of a rupture, a medical opinion is recommended.

Expected recovery timeline for Achilles tendinopathy

This tendinopathy calls for patience: the Achilles tendon responds more slowly to treatment than other tendons, with gradual improvement typically spread over several weeks to a few months depending on how long the symptoms have been present. How consistently you do the eccentric strengthening is the biggest factor in how fast you recover.

Preventing recurrence

Once the pain is under control, a few measures help stop it coming back:

• Keep up maintenance eccentric calf strengthening, even once symptoms are gone
• Increase training volume gradually, staying under around 10% per week
• Maintain good ankle dorsiflexion mobility
• Adapt terrain and footwear when returning to activity after a break

The HOPP care programmes to treat your Achilles tendinopathy and get back to sport

This tendinopathy requires rigorous, progressive eccentric strengthening. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.

The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.

A programme that adapts to you every day

Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your ankle is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.

Ready to start your programme?

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