Achilles tendinopathy is a common cause of pain at the back of the ankle or lower calf. It develops when the Achilles tendon – the strong tendon connecting the calf muscles to the heel bone – becomes irritated and unable to tolerate repeated load. This often occurs gradually rather than after one specific injury.
Common Symptoms
Achilles tendinopathy is common in runners, field sport athletes and active individuals, but it can also affect less active people. Sudden increases in training load, poor recovery, calf weakness, reduced ankle mobility, footwear changes and biomechanics can all contribute.
Diagnosis
Diagnosis is usually made through a detailed consultation and physical examination. This includes discussing training history, symptoms and aggravating activities, as well as assessing calf strength, ankle movement, tendon tenderness and swelling. In some cases, ultrasound or MRI scanning may be recommended to confirm the diagnosis or assess the extent of tendon changes.
In most cases Achilles tendinopathy improves with conservative treatment and does not require surgery.
Physiotherapy is the mainstay of treatment, focusing on progressive calf strengthening, tendon loading exercises, mobility work and correction of training errors. Advice on footwear, activity modification and return-to-sport planning are also important.
If symptoms are persistent, injection therapy may be considered in selected cases. Ultrasound-guided treatments can help target areas around the tendon, particularly where inflammation of surrounding tissues is contributing to pain. Regenerative options such as PRP may also be discussed for longer-standing cases.
Shockwave therapy is a well-established treatment for chronic Achilles tendinopathy and can help stimulate healing and reduce pain when rehabilitation alone has not been enough.
Most patients improve with a structured, consistent approach and can return successfully to exercise and sport.
