Achilles tendon injuries

Achilles tendon injuries and problems are very common in athletes, particularly runners.

The Achilles tendon is the large tendon at the back of the ankle. The Achilles connects the calf muscles to the heel bone and provides push off in walking, running and jumping. Often Achilles tendon problems can be elicited following a degenerative process that has been underlying for sometime due to altered biomechanics of the foot. Alternatively these can also be a result of overload when activity is increased beyond its tolerable limits.


The tendon can become weakened through overuse. When this happens cells will migrate from the sheath and other surrounding structures to the tendon, often forming new and pathological blood vessels. This process is known as neovascularisation.

Causes often include:

  • Excessive or unaccustomed running;
  • Poor biomechanics (i.e. poor knee movement / flattened foot arch / poor big toes mobility);
  • Wearing inadequate or incorrect footwear;
  • Running or walking on hard or uneven surfaces.

What do I feel?

  • Pain in tendon during exercise (gradual onset) – particularly running/loaded exercise;
  • Often, but not always, there will be swelling / redness / tenderness over the tendon area;
  • Often there will also be pain/stiffness in the morning or after prolonged periods of rest and then initial loading.

What can I do?

  • Reduce / modify activity through decreasing load, temporarily stopping running and regularly taking load off the foot;
  • Apply ICE (Ice, Compression and Elevation) to tendon;
  • Wear heel raises / foot orthotics to decrease strain on tendon and have your foot mechanics (both with running and with walking) reviewed by a professional.

Engaging in an effective rehabilitation programme with a physiotherapist is also recommended.

Rehabilitation will usually consist of a home exercise programme to address some of the mechanical predispositions that the individual may have, this will typically include calf strengthening +/- Gluteal strength and pelvic/hamstring strengthening. Rehabilitation may also include stretches for the calf, shin and plantar fasica (sole of the foot). Some physiotherapy techniques may also involve trigger point therapy, deep tissue massage, ergonomic advice and activity modification.

If Achilles tendon injuries are treated at an early stage, you should be able to make a good recovery. The tendon can take prolonged period of time to heal as it has a poor blood supply, but be patient, follow guidance from your therapist and continue to do your exercises. Poor management of an Achilles tendinopathy occasionally will lead to a chronic problem so it is essential to manage the injury appropriately.

This information is intended as a guide only. For specific information regarding injury assessment and management, you should always consult your health professional.