Achilles Tendonitis: Easing Back-of-Heel Pain
The Achilles is the body's strongest tendon, but it is prone to overload. Achilles tendonitis brings pain and stiffness behind the heel that is worst on the first steps of the morning.
What it is
Achilles tendinopathy is degeneration and irritation of the tendon connecting the calf muscles to the heel bone. It comes in two forms: mid-portion (a few centimetres above the heel) and insertional (right where the tendon meets the heel). Telling them apart matters because treatment differs slightly.
Symptoms
- Stiffness and pain at the back of the heel, worst with the first morning steps
- Aching that warms up with activity then returns afterwards
- Thickening or a tender nodule along the tendon
- Reduced push-off power when walking or running
Causes
Most cases are overload injuries: a sudden jump in running mileage, hill work, tight calves, worn shoes, or starting intense activity after a sedentary spell. Age-related tendon stiffening and certain antibiotics also raise risk.
Treatment and exercises
The evidence-backed cornerstone is eccentric calf loading: slow heel-drop exercises off a step (keep heel drops level with the ground for insertional cases). Add calf stretching, load management, and a small heel lift to offload the tendon. Recovery is measured in months, not days, so consistency matters. The Mayo Clinic emphasises gradual loading and avoiding sudden activity spikes.
When to get help
Frequently asked questions
- Should I keep running with Achilles tendonitis?
- Reduce volume and intensity rather than stopping entirely; pain-guided loading and heel-drop exercises usually help more than complete rest.
- How long does Achilles tendonitis take to heal?
- With consistent eccentric exercise it often improves over 6-12 weeks, but stubborn cases can take several months.
Sources & further reading
- Foot and ankle health, Mayo Clinic
- Foot problems, NHS
- Patient resources, American Podiatric Medical Association (APMA)