Achilles tendinopathy in Hull: symptoms, rehabilitation and current evidence

Understanding the tendon

What is Achilles tendinopathy?

The Achilles tendon connects the calf muscles to the heel bone and must tolerate substantial force during walking, running and jumping. Symptoms can develop when the demands placed on the tendon exceed its current capacity. This may follow an increase in running, hill walking, sport, gym training or physically demanding work, but it can also affect people who are not especially active.

Longstanding Achilles pain is not necessarily caused by continuing inflammation. The term tendinopathy describes pain and reduced function associated with the tendon without assuming that inflammation is the only process involved. Read the RNOH patient guide.

Symptoms and location

What does Achilles tendinopathy feel like?

• 01
  Morning stiffness

  The first steps after sleep or rest may feel stiff and painful.

• 02
  Load-related pain

  Walking, running, jumping, stairs or repeated heel raises may provoke symptoms during or afterwards.

• 03
  Local tenderness

  The tendon may be tender, swollen or thickened, with reduced calf strength or heel-raise capacity.

Midportion Achilles tendinopathy

Pain is usually felt approximately two to six centimetres above the heel bone. There may be a tender or thickened area within the tendon.

Insertional Achilles tendinopathy

Pain is situated where the tendon attaches directly to the heel. Shoes may rub against the area, and deeper ankle bending can compress the tendon against the heel. Exercises that lower the heel below the edge of a step may aggravate an irritable insertional presentation, so heel raises from a flat surface can be a more suitable starting point.

Pain around the back of the heel can also arise from bursitis, heel-bone changes, inflammatory disease, nerve irritation or a partial tendon injury. Location alone does not confirm a diagnosis.

Assessment before treatment

How is Achilles tendinopathy assessed?

Diagnosis can normally be made from the history and clinical examination. An assessment considers the precise location of pain, how symptoms began, morning stiffness, next-day reactions, recent changes in activity, footwear, relevant health conditions and medicines. Examination may include ankle movement, calf strength, heel raises, balance and—in suitable cases—hopping or running.

The 2024 clinical practice guideline supports clinical assessment and progressive tendon-loading exercise as central components of managing midportion Achilles tendinopathy. Read the clinical practice guideline.

Do I need an ultrasound or MRI scan?

Not routinely. Imaging may be considered when the diagnosis remains uncertain, symptoms followed a significant injury, a partial tear or rupture is suspected, another condition may be causing the pain, progress is unexpected or the result would genuinely change management.

Ultrasound can assess the tendon and surrounding tissues. MRI may be appropriate when more detailed assessment is required. Imaging findings should be interpreted alongside symptoms, examination and function rather than used alone to predict recovery. Musculoskeletal assessment at Resolve starts by deciding whether imaging would answer a useful clinical question.

A progressive plan

What treatment can help?

Modify aggravating activity rather than stopping everything

Complete rest is not normally necessary. Running distance, speed, hills, jumping or repeated stair climbing may need temporary adjustment. Cycling, swimming or another tolerable activity can sometimes maintain fitness while the tendon settles. Activity is then rebuilt rather than resumed at full intensity.

Progressively strengthen the calf and tendon

Progressive loading is the foundation of rehabilitation. A programme may move from supported calf contractions and double-leg heel raises to single-leg work, straight- and bent-knee strengthening, additional resistance, faster movements, hopping and running or sport-specific loading.

Traditional eccentric heel drops are one option, but they are not the only useful exercise. Slow resistance training and combined raising-and-lowering exercises may also be used. For insertional tendinopathy, the initial range may need limiting to reduce compression at the heel.

Monitor the overall response

Mild, controlled discomfort during rehabilitation is not automatically harmful. More useful checks are whether symptoms settle after the session, morning stiffness is clearly worse the next day, walking technique changes and strength or function is improving over time. Sharp pain, increasing weakness or steadily worsening symptoms require review.

Use footwear and hands-on treatment as supporting measures

Footwear that does not rub the painful area can help. A temporary heel lift may make walking more comfortable for selected people, but it does not replace strengthening. Manual therapy may temporarily help relevant ankle stiffness or discomfort; massage or mobilisation alone is unlikely to rebuild the capacity needed for walking, running or sport.

Private physiotherapy in Hull can provide an individual starting level, progression criteria and return-to-activity plan rather than a generic exercise list.

Other interventions

Are injections or surgery recommended?

Corticosteroid injection into or immediately around the Achilles tendon is generally avoided because of concern about tendon damage and rupture. Evidence supporting platelet-rich plasma and other injectable products remains uncertain, and they should not be presented as routine first-line substitutes for rehabilitation.

Surgery is rarely the first treatment. The Dutch multidisciplinary guideline recommends beginning with non-surgical care and considering surgery only after at least six months of appropriate basic management and carefully selected additional treatment without sufficient improvement. Read the multidisciplinary guideline.

Recovery

How long can improvement take?

Achilles rehabilitation normally takes longer than a few days or weeks. A structured programme commonly continues for at least 12 weeks, while longstanding or highly irritable symptoms may take several months to improve. Recovery is not always linear.

Useful signs of progress include less morning stiffness, improved walking tolerance, increased heel-raise strength, fewer next-day reactions and a gradual return to running, work or sport. The sports injury rehabilitation service can help connect tendon strength with the demands of your chosen activity.

Safety first

When should Achilles pain be assessed urgently?

Achilles rupture pain can sometimes settle after the initial injury, so reduced pain does not reliably exclude it. Rapid calf swelling accompanied by chest pain or breathlessness requires emergency medical help. Read the NHS hospital guidance.

Persistent unexplained night pain, progressive swelling, unexplained weight loss or feeling generally unwell also requires medical review.

Achilles assessment in Hull

How Resolve MSK Clinic approaches Achilles pain

Assessment considers whether the presentation is midportion or insertional, calf strength and endurance, ankle movement, walking or running demands, recent changes in activity, relevant health factors and whether another condition or rupture requires investigation.

Management may include explanation of the likely diagnosis, temporary activity modification, progressive calf and tendon loading, footwear advice, walking or running progression, and imaging or onward referral when clinically justified.

Learn more about Achilles tendinopathy treatment in Hull, ankle pain treatment, private physiotherapy and musculoskeletal assessment at Resolve.