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Achilles Tendinitis (Tendinopathy)

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Achilles tendinitis refers to inflammation and degeneration of the Achilles tendon, connecting the calf muscles to the heel bone. It is a common cause of pain and stiffness in the back of the ankle, particularly in runners and active individuals.

Two Forms

• Non-insertional: Affects the middle portion of the tendon
• Insertional: Involves the area where the tendon attaches to the heel bone — may also involve a bony spur

Symptoms

• Pain and stiffness at the back of the heel or lower calf, particularly in the morning
• Tenderness and swelling along the tendon
• Pain that worsens with walking, running, or climbing stairs
• A thickened or nodular tendon in chronic cases

Causes

• Sudden increase in physical activity or training intensity
• Poor footwear or running technique
• Tight calf muscles and reduced ankle flexibility
• Overuse in sports with repetitive jumping or running
• Underlying foot biomechanics (flat feet or high arches)
• Age-related tendon degeneration

Non-Surgical Treatment

• Activity modification and rest
• Ice and anti-inflammatory medication
• Heel lifts or orthotics to reduce tendon tension
• Eccentric calf strengthening (Alfredson protocol) — the gold standard exercise programme
• Physiotherapy for stretching and rehabilitation
• Extracorporeal Shockwave Therapy (ESWT) — highly effective in chronic cases
• Night splints and taping techniques

Surgery

Reserved for patients who fail to respond to a full course of conservative care including shockwave therapy. Options include:

• Debridement of degenerated tendon tissue
• Removal of retrocalcaneal bursae or calcific spurs (insertional)
• Tendon reinforcement or augmentation if significant degeneration is present
• Proximal medial gastrocnemius recession: A small release of the calf muscle to reduce tension on the tendon — often performed alongside tendon debridement

Recovery

Timeframe	What to Expect
0–2 weeks	Rest. Bulky dressing or back slab. Non-weight-bearing.
2 weeks	Wound review. Transition to boot.
2–6 weeks	Gradual weight-bearing in boot. Gentle movement.
6–12 weeks	Physiotherapy begins. Wean out of boot.
3–6 months	Progressive return to full activity and sport-specific rehab.
6–12 months	Full recovery and return to impact activity.