Achilles Tendinopathy

What Is It

The Achilles tendon connects the calf muscles to the heel bone and transmits force with every step, run and jump. Tendinopathy is a degenerative change in the tendon's structure caused by cumulative overload — common in footballers and basketball players from repeated sprinting, jumping and sudden stops — occurring at two typical sites: the mid-portion of the tendon or its insertion at the heel bone.

Signs & Symptoms

• Pain and stiffness in the tendon in the morning, partially easing after a few steps
• Pain that worsens with running, rising onto the toes, and particularly with sprinting and jumping
• Visible or palpable thickening of the tendon a few centimetres above the heel bone
• Tenderness on pressure along the tendon or at the heel insertion
• Gradually reduced training tolerance over the weeks

Cause & Mechanism

Develops through cumulative tendon overload from a sudden increase in running mileage, a change in surface or footwear, calf muscle weakness, or reduced ankle mobility. Risk increases with age, as the tendon's capacity for collagen renewal declines over time.

Diagnosis

Clinical examination identifies the location of pain and thickening along the tendon. Ultrasound shows structural changes in the fibres and any calcification at the insertion, while MRI provides a more precise picture for prolonged symptoms or before an intervention is considered.

Treatment With Us

The foundation of treatment is a progressive calf-strengthening programme, starting with isometric loading for pain control, followed by eccentric and finally explosive strengthening, alongside a temporary adjustment of running volume. For persistent cases treatment is complemented by a review of running technique and footwear to address the underlying cause of overload.