Quick Facts on Achilles Tendinitis

There are two types of Achilles Tendinitis:

Insertional Achilles tendinopathy

  • Pain at the bottom of the Achilles tendon (where it connects into the heel bone)
  • Caused by compressive forces of the tendon on the heel bone when the ankle is dorsiflexed (foot flexed upwards)

Mid-portion Achilles tendinopathy

  • Pain 2-6cm up from the bottom of the Achilles tendon
  • Usually caused by overuse of the tendon
Achilles tendinitis insertional tendinopathy and mid-portion tendinopathy

What causes Achilles tendinitis?

  • Placing more load/stress on the tendon than it is capable of
  • A sudden increase in amount/type of activity or gradual overuse
  • Recent antibiotic use (fluoroquinolones)

Common complaints:

  • Gradual onset of pain
  • Pain with taking first steps in morning
  • Feeling of calf stiffness/tightness
  • Pain to touch the back of heel or Achilles tendon
  • Pain with jumping, squatting, running, going up and down stairs
  • An increase in pain the day after lots of exercise
  • Pain slowly resolves with rest, but returns with activity

How can therapy help?


  • A review of your current training regimen and any recent changes
  • Markerless motion capture movements to determine range of motion and strategies used for squatting, jumping, landing, etc.
  • Strength testing of the lower limb muscles to determine a baseline starting point and any imbalances
  • Running analysis (if this is an activity you do)
  • Determining a treatment plan based on your specific goals


  • Load management of the tendon:
    • Reducing or modifying activities (reducing frequency, volume, and/or high-stress activities) to a point that the tendon can tolerate
    • A progressive loading program to help the tendon adapt to the demands of your sports/lifestyle
  • Pain relief exercises and advice
  • Manual therapy and exercise to address any range of motion or strength deficits determined in the assessment
  • Heel lifts are sometimes recommended to reduce compressive forces on the tendon (for insertional tendinopathy)

For a more detailed explanation on tendon pain and injuries, check out our tendinopathy blog.