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Achilles Tendinopathy

Posted on 18 March 2015
Achilles Tendinopathy

Do you have ongoing pain in your heel that has lasted longer than 3 months? Do your arches appear flattened? Do you have tight calves? Are you a runner? Have you recently changed your training program? If so, read on!

Background Information

The Achilles tendon is documented to be the largest and strongest tendon in the body. Half of the tendon is comprised of fibers from the gastrocnemius and half from the soleus muscle. Achilles tendon injuries are the most frequently reported overuse injuries in literature. The most common demographic of people with Achilles pain are runners and people between age 30-50.

Achilles tendinopathy is a diagnosis that refers to an injury of the Achilles tendon, whether acute or chronic. Typically an individual will experience pain in the middle of the Achilles tendon with or without swelling or thickening of the tendon. The pain may be related to exercise or activity and can be more pronounced after prolonged sitting or sleeping. Some individuals experience stiffness and pain when starting to exercise; it can loosen up during the exercise; then pain may become more pronounced towards the end of exercise once the tendon fatigues. Other symptoms include pain with pushing off while doing a calf raise, negotiating stairs, stretching, prolonged walking or running.

Unfortunately, age can have an impact in increasing the possibility of developing a tendon injury. As we get older, the diameter of collagen fibers decrease in size and density due to decreasing water and protein content. This in turn can result in decreased strength and increased stiffness in the tendon. The literature documents these changes occurring as early as the age of 35. This is why it is important to prevent injury through frequent stretching, strengthening and balance training; or seek treatment early when such a pain arises. The signs, risk factors and treatment options for Achilles tendinopathy are listed below.

Risk Factors

If you are experiencing Achilles pain and any of the following apply to you, an assessment performed by one of our health professionals can help identify the issue.
  •     Decreased dorsiflexion range of motion (bringing your toes up towards you). This can lead to increased tension on the Achilles tendon during activity and cause it to be more vulnerable to forces specifically with running or field sports.   
  •     Stiffness in the heel   
  •     Excessive foot pronation. This may be hard to detect on your own. However, you can assess your shoes for any increased thinning of the tread on the inside.   
  •     Weakness and increased fatiguability of the calf muscles
  •     Environmental factors such as old or faulty equipment, a sudden increase in running mileage, change in training schedule, increase in workout intensity, hill training commencement, or resuming workouts after a prolonged layoff.


The key to a successful recovery from Achilles tendon pain is early detection and treatment. If you have had pain for more than 10 days and there is no resolution of your symptoms, you should seek treatment.

If you have had the Achilles tendon pain for longer than 3 months, you may have a more chronic injury known as an Achilles tendinosis. With a tendinosis, the tendon is no longer inflamed; rather the tendon is in a state of degeneration. The actual internal chemistry of the tendon changes due to chronic repetitive strain. This leads to decreased collagen size and strength, small micro-tears, calcification and even necrosis of the tendon. This is why Achilles pain that has lasted for a long time can take a significantly greater time to heal.

Seeking treatment early and preventing Achilles injury through identifying the risk factors can help for a quicker recovery.


There are many well-documented methods of treatment in the literature:
  •     Physiotherapy including soft tissue mobilizations, stretching program and an eccentric strengthening program
  •     Massage therapy for deeper soft tissue mobilizations
  •     Podiatry for gait analysis and castings of foot orthotics to correct pronation
  •     Shockwave therapy performed for stubborn Achilles tendinosis
  •     Plasma rich platelet (PRP) treatments performed by a sports medicine doctor
Our knowledgeable team at Toronto SEMI provides all of the above treatments as well as prevention of re-injury and returning to your sports and normal functional activities.


    Christopher R Carcia, Robroy L Martin, Jeff Houck, Dane K Wukich; Achilles Pain, Stiffness and Muscle Power deficits: Achilles Tendinitis. J Orthop Sports Phys Ther. 2010; 40 (9) A1-A26
    Sports Med (1999) 27(6): 393-408 K.M Khan, J.L Cook, F.Bonar, P.Harcourt, M.Astrom
Tags: Lower body Treatment options


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