What Is Achilles Tendon Pain?
The Achilles is the thick tendon running from the calf muscles to the back of the heel, and it carries more load than any other tendon in the body. Achilles tendon pain, or tendinopathy, is what happens when the demand placed on it outstrips its ability to adapt, and the tendon becomes painful and stiff.
Two places it hurts, and why it matters
Pain in the middle of the tendon, a few centimetres above the heel, and pain right where the tendon attaches to the heel bone are treated differently. Pain at the attachment can also involve the bursa or a bony enlargement at the back of the heel, which is Haglund’s deformity, so where exactly it hurts is one of the first things your podiatrist establishes.
What Causes Achilles Tendon Pain?
Achilles pain is usually a load problem rather than a single injury. It typically follows a change: more running, faster running, hills, a new surface, a return after time off, or a change of shoe.
- An increase in training load, or a return to running after a break.
- A change in surface, gradient or footwear, including a drop in heel height.
- Calf tightness, which increases the tension the tendon carries.
- Foot mechanics, including excess pronation, which alters how the tendon is loaded.
- Pressure from the rigid back of a shoe where the tendon attaches.
Symptoms to Look Out For
The pattern is characteristic: stiff and sore to start, better once warm, sore again afterwards and worse the next morning.
- Pain and stiffness in the tendon on the first steps of the morning.
- Pain that eases as the tendon warms up during activity, then returns afterwards.
- Tenderness when the tendon is squeezed.
- Thickening of the tendon, or a bump at the back of the heel.
- Difficulty pushing off, or rising onto the toes.
A sudden, sharp pain in the back of the ankle during activity, often described as feeling like being kicked or struck, along with difficulty walking or pushing off, needs urgent assessment rather than a routine appointment. That presentation is not the gradual tendon pain this page describes.
How Is Achilles Tendon Pain Diagnosed?
Diagnosis is clinical. Your podiatrist takes a history of the pain and of what changed in your training or footwear before it started, examines the tendon along its length to locate the painful section, tests calf strength and flexibility, and watches you walk and where relevant run. Imaging is arranged where it is needed to confirm the diagnosis or to distinguish it from another cause of pain at the back of the heel.
Conservative Treatment Options
Tendons respond to load, so treatment is rarely complete rest. It is a staged programme that reduces what irritates the tendon while progressively loading it so it can adapt, alongside addressing the mechanics underneath it.
- A progressive calf and tendon loading programme, set to your stage and reviewed as it changes.
- Adjusting training: volume, surface, gradient and pace, rather than stopping entirely.
- Stretching exercises help relieve tension from the Achilles tendon. These exercises are especially important for the patient who has a tight heel cord.
- Heel lifts placed inside the shoe decrease the pressure on the heel, and backless or soft backed shoes help avoid or minimise irritation at the attachment.
- Custom orthoses where foot mechanics are loading the tendon unevenly.
When Symptoms Persist
Achilles tendon pain that has not settled over months is common and is not a sign that the programme has failed, but it does mean the plan should be reviewed rather than repeated. Manly Foot Clinic delivers shockwave therapy on site, which is non-invasive and is used for chronic tendinopathy.
Where pain sits at the attachment and a bony enlargement at the back of the heel is contributing, that is assessed as Haglund’s deformity, and if non-surgical treatment fails to provide adequate pain relief, surgery may be needed. A surgical podiatrist consults at the clinic, so that opinion does not require a separate referral.
Achilles Pain in Children and Teenagers
Pain at the back of the heel in a child between roughly eight and fourteen years of age is most often calcaneal apophysitis, also known as Sever’s disease, an irritation of the growth plate where the Achilles tendon attaches. It is common in active children during periods of rapid growth, it is a different condition from Achilles tendinopathy, and it is assessed on its own terms.
Achilles Tendon Pain FAQs
Tendons respond to load, so treatment is rarely complete rest. A staged programme reduces what irritates the tendon while progressively loading it so it can adapt. Your podiatrist sets the stage and reviews it as the pain changes.
The characteristic pattern is stiffness and soreness on the first steps of the morning, easing as the tendon warms up during activity, then returning afterwards and being worse the next morning.
Often yes, at an adjusted volume, surface and pace, but that depends on the stage the tendon is at. It is the question to bring to your assessment rather than to answer from a web page.
Manly Foot Clinic has not published a typical recovery time, so this page does not state one. Tendon problems are generally measured in months rather than weeks, and your podiatrist will set milestones for your case at the assessment.
No, you can book directly without a referral. If you’d like, we’ll send a short report to your GP after your appointment so your foot care stays part of your overall health record. If your appointment is through a Medicare care plan, DVA or another funded program, you will need a referral, so check with us when you book.
Serving Manly and the Northern Beaches.
Manly Foot Clinic is at Shop 3/3 Corrie Rd, North Manly, NSW 2100, and treats Achilles tendon pain for runners and active adults from Manly, Dee Why, Brookvale, Freshwater and Balgowlah. The clinic is open Monday to Friday from 8:30am to 5:30pm and Saturday from 8:00am to 2:00pm.