Achilles Tendinopathy

Also Known as Achilles Tendonitis or Achilles Tendinosis

This article is by Zak Buttle the physiotherapist in Islington at the Angel Sports Injury and Physiotherapy Clinic. Zak has a keen interest in sport related injuries and is a cyclist with the Islington Cycling Club and cycles regularly both locally and in the Alp’s.

Achilles Tendinopathy, Achilles Tendinitis or Achilles Tendinosis is a very common condition characterised by pain and/or swelling in the Achilles - the soft tissue connecting the calf muscle to the calcaneus (heel bone).


Many different factors can contribute to Achilles tendinopathy such as:

• Increased activity
• Change in activity
• Age
• Diabetes
• Tightness in the calf muscles
• Tightness in the plantar fascia
• Instability in controlling muscle groups

All of the above contribute to an increase in the loading of the tendon and therefore can cause undue strain on its tissue. This causes the strained response and the tendon becomes symptomatic.

Due to the many factors that can lead to an Achilles tendinopathy, both athletic and non-athletic individuals can develop this pathology. It does not usually involve a single injury when the individual may feel it ‘go’, but the pain may first be felt coming on during or after a single day, run, cycle etc.

So far, research has proved inconclusive as to what the physiological cause of Achilles tendinopathy may be. Swelling, microtears within the tissue, and increased water content have all been theorised as to being the reason for symptoms, but none have been proven conclusively.


Local pain - This is normally felt in weight bearing positions, whereby would weight is put through the foot, and an increase in demand is placed through the Achilles. It will likely increase when powering off of the affected foot, increasing the tension placed through this tendon further. Pain can also be felt after such activities.

Radiating pain - less commonly, pain is felt to radiate into the calf and/or the sole of the foot.

Swelling - thickening and swelling of the Achilles can often be felt and occasionally observed.


Recent research (Cook and Purdam, 2009) categorises tendons into the below categories that, once diagnosed, direct us towards the treatment that is required.

Reactive tendinopathy - This is more common in the individual with an acute change in the amount of strain placed tough the tendon.

Tendon disrepair - This stage follows the reactive tendinopathy if the Achilles is not properly treated. Its clinical appearance is similar, but symptoms tend to be more severe.

Degenerative tendinopathy - More common in the older athlete/individual. Structures within the soft tissues have changed and are unable to deal with the load placed through.


This is most commonly made via clinical assessment; observation, reproduction of the symptoms via palpation and assessment of the surrounding structures can confirm or deny the presence of Achilles tendinopathy. This is normally enough to diagnose an Achilles tendinopathy with a high degree of certainty.

An ultrasound scan or an MRI scan can also be used to rule in or out any other potential conditions if a there is any scepticism of over the diagnosis of an Achilles tendinopathy.


Identifying the correct stage is important as it directs treatment. Choosing the wrong treatment can make it worse!

Rest - This is often needed to reduce the loading of the tendon to avoid disrepair.

Strengthening the Achilles - This can be done in many different ways. Different programmes such isometric, concentric, and concentric/eccentric programmes are all appropriate at different times/stages, but should be discussed with a qualified physiotherapist.

Soft tissue massage - This can be used to settle symptoms by moving the swelling and desensitising the tissue

Acupuncture - Facilitates the increase in proliferation of the tendon to allow for greater healing. Pain can also be reduced by hyper stimulation using acupuncture needles.

Activity planning - A solid plan to rest and then a graded increase in the activity back to sporting activities is recommended.

Stretching - this is often recommended by physiotherapists but can actually increase symptoms.

If you have been inspired to start cycling by watching the Tour de France or if you have upped your mileage for the upcoming Ride London and have started to have Achilles pain then an appointment with Zak the physiotherapist in Islington may keep you training and not convalescing.

If you have been out playing tennis since watching Wimbledon and have started getting Achilles pain then see Zak at our Islington physiotherapy clinic for treatment and prevent the injury from stopping you entering next years Wimbledon!

If you want an appointment click below or call the clinic on 020 7288 2999




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