Sore at the back of your heel or lower calf, especially with first steps or after a run? This quick-read guide answers the most common questions about Achilles tendonitis/tendinopathy — short, sharp, and helpful.
Common Questions About Achilles Tendonitis
Q: What is Achilles tendonitis (tendinopathy)?
A: Irritation or degeneration of the Achilles tendon (the cord at the back of your ankle). “Tendonitis” suggests inflammation; “tendinopathy” covers the broader overuse/degenerative process.
Q: What causes it?
A: Overload from sudden training increases, poor calf flexibility/strength, tight footwear, hard surfaces, or biomechanical issues like overpronation.
Q: What are typical symptoms?
A: Pain and stiffness at the back of the heel or just above it, worse with first steps in the morning or after rest; swelling or a tender lump can appear.
Q: What’s the difference between mid‑portion and insertional Achilles problems?
A: Mid‑portion pain is 2–6 cm above the heel bone; insertional pain is where the tendon attaches to the heel and can be aggravated by uphill running or high dorsiflexion.
Q: Who’s at risk?
A: Runners, jumpers, people who rapidly ramp activity, those with tight calves, flat feet/high arches, or prior fluoroquinolone antibiotic or steroid exposure.
Q: How is it diagnosed?
A: Clinical exam is usually enough. Ultrasound or MRI may be used for persistent or unclear cases.
Q: What helps in the first 1–2 weeks?
A: Relative rest (reduce but don’t stop all movement), ice after activity, gentle calf stretches (pain‑free range), heel lifts, and switching to supportive footwear.
Q: Do I need to stop running completely?
A: Not always. Cut volume/intensity, avoid hills/speed work, and keep pain ≤3/10 during and after. If pain lingers or worsens, pause running and cross‑train.
Q: Which exercises work best?
A: Progressive calf loading (eccentric and slow heavy heel raises) is the gold standard. Start on the flat; progress to weighted and decline work as tolerated (especially for mid‑portion).
Q: Should I stretch?
A: Gentle calf stretches can help stiffness, but heavy loading/strength work is more important for long‑term recovery.
Q: Are heel lifts or orthotics useful?
A: Temporary heel lifts reduce tendon strain, especially for insertional pain. Orthotics can help if overpronation or mechanics contribute.
Q: What shoes are best for Achilles issues?
A: Supportive trainers with slight heel‑to‑toe drop, good cushioning, and a stable rearfoot. Avoid very minimal/flat shoes during recovery.
Q: Do night splints help?
A: They’re more established for plantar fasciitis. For Achilles Tendonitis, results are mixed; some find reduced morning stiffness.
Q: Are injections recommended?
A: Corticosteroid injections carry a small rupture risk around tendons and are generally avoided. PRP and other biologics have mixed evidence; discuss with a specialist.
Q: Does shockwave therapy (ESWT) work?
A: It can help some stubborn cases, especially alongside a structured loading programme.
Q: How long until it gets better?
A: Many improve in 6–12 weeks with consistent loading; stubborn cases can take 3–6 months. Tendons heal slowly — consistency beats intensity.
Q: When should I see a clinician?
A: If pain persists beyond 2–4 weeks, limits walking, you notice a visible lump/swelling that isn’t settling, or you’re unsure how to load safely.
Q: How do I know if it’s a rupture?
A: A sudden “pop,” sharp pain, difficulty pushing off, and a gap you can feel — seek urgent care.
Q: Can it come back?
A: Yes. Return gradually, keep up calf strength, rotate footwear, and avoid big training spikes.
Q: How can I prevent Achilles problems?
A: Build mileage slowly, strengthen calves (bent‑ and straight‑knee raises), keep calves flexible, wear supportive shoes, and vary surfaces.
📌 Summary
- Most Achilles pain stems from overload; tendons prefer gradual, consistent loading.
- Strength work (eccentric/slow heavy raises) beats rest alone.
- Supportive shoes + temporary heel lifts can ease strain.
- Seek help early if pain lingers or you suspect a rupture.
Need More Information? Read my The Best Shoes For Achilles Tendonitis Guide