Achilles Tendinopathy: Causes, Diagnosis, and Effective Treatments

November 1, 2023

Achilles tendinopathy is a common condition that affects the Achilles tendon, the strong band of tissue that connects your calf muscles to your heel bone. It is a condition often seen in athletes and active individuals but can also occur in people who are not physically active. In this blog post, we will explore the causes, diagnosis, and various treatments for Chronic Achilles tendinopathy, including loading programs and role of shockwave therapy.

Causes of Achilles Tendinopathy

Overuse: One of the primary causes of Achilles tendinopathy is overuse or repetitive stress on the tendon. This can happen in athletes who engage in activities that involve a lot of running and jumping, such as basketball, soccer, and track and field. 

Poor Foot Biomechanics: Anomalies in foot structure and biomechanics can put extra strain on the Achilles tendon. Issues like flat feet, high arches, or excessive pronation may increase the risk of developing tendinopathy.

Inadequate Footwear: Ill-fitting shoes or those lacking proper support can contribute to Achilles tendinopathy. Footwear that does not provide proper cushioning and arch support can increase the risk of injury.

Sudden Increase in Activity: A rapid increase in the intensity or duration of physical activity, known as “overtraining,” can overload the Achilles tendon and may lead to tendinopathy.

Age: As we age, our tendons become less flexible and more prone to injury. Middle-aged and older individuals are more susceptible to Achilles tendinopathy.

Diagnosis of Achilles Tendinopathy

Your clinician may ask about your physical activity level, footwear, and any recent changes in your exercise routine to understand the potential causes of your tendinopathy.

Diagnosing Achilles tendinopathy typically involves a thorough physical examination by a healthcare professional. They will assess your symptoms, medical history, and perform specific functional tests to pinpoint the issue. Common diagnostic methods include:

Functional Examination:
Range of motion and strength assessments may be conducted to evaluate the extent of the injury and evaluate the capacity of the calf muscles and rest of the chain.

The healthcare provider will gently palpate the Achilles tendon to identify areas of tenderness or swelling.

In some cases, imaging tests such as ultrasound or magnetic resonance imaging (MRI) may be used to visualise the condition of the tendon and rule out other injuries or condition.


Treatments for Achilles Tendinopathy

Achilles tendinopathy can be challenging to treat, and the approach may vary depending on the severity of the condition. Here are some common treatment options, including two specific therapies: Staged loading program  and shockwave therapy.

Physical Therapy: Your clinician can design an incremental loading program which can help to improve pain and function. This may include Isometric , heavy slow resistance and energy storage exercises.

Orthotics: Custom orthotic inserts for your shoes can correct foot biomechanics issues and provide better support for the Achilles tendon.

Medications: In some cases Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce pain and inflammation.

Isometric Loading: Isometric loading exercises involve contracting the muscles around the Achilles tendon without causing tendon movement. These exercises can help improve tendon strength and reduce pain.

Shockwave Therapy: Shockwave therapy, or extracorporeal shockwave therapy (ESWT), is a non-invasive treatment that uses high-energy shockwaves to stimulate the body’s natural healing processes. It has shown promise in promoting tissue repair and reducing pain associated with Achilles tendinopathy.

Surgical Intervention: In severe cases that do not respond to conservative treatments, surgical intervention may be necessary to repair or remove damaged tendon tissue.


Achilles tendinopathy is a common condition that can cause significant pain and discomfort, especially in athletes and active individuals. Early diagnosis and appropriate treatment are crucial for a successful recovery. While conservative treatments such as shockwave therapy and graded loading program offer promising options for those seeking relief from Achilles tendinopathy. If you suspect you have Achilles tendinopathy, consult with a healthcare professional for a proper diagnosis and personalised treatment plan. To book a consultation or treatment you can complete our contact form.