Understanding Achilles tendon problems and building activity back up

Symptoms may be located directly where the tendon attaches to the heel bone or a few centimetres above it. At the attachment, mechanical loading in certain foot positions is one factor. A strong stretch that lowers the heel well below a step may therefore be unhelpful in this area. An exercise programme should account for these differences. The starting position, range of movement and load are adapted to the examination findings and your response. Do not therefore adopt a demanding programme using a step without assessment simply because it was recommended for the Achilles tendon. This website explains the underlying principles; the precise amount and intensity belong in your individual treatment plan.

The location of the pain, when it started and the pattern of activity are important for assessment. We want to know how the tendon behaves during and after an activity. Previous injuries, operations, new medication and other conditions are also part of the discussion. Bring your medication list and do not change an existing treatment solely because of information on a website. The physical examination assesses the tendon in relation to the foot, ankle and function. Ultrasound may add information when there is an appropriate question to answer. Other imaging is used if it is needed to address a relevant unanswered question. The tendon’s appearance and what you can do in daily life are assessed together. Treatment is not guided solely by whether an image looks as normal as possible.

For longer-standing tendinopathy, gradually adapting and rebuilding tendon loading is often a key part of treatment. Complete rest for a long time does not automatically restore the tendon’s capacity. Equally, continuing to train without changes may overload it. We want to agree a level of activity that you understand and can put into practice in daily life. At first, this may mean changing activities that particularly trigger symptoms while continuing those you tolerate better. Targeted calf exercises are selected according to the findings and adjusted gradually. Your feedback matters: how does the tendon feel the next morning? Is the same walking distance becoming easier? Is there a marked deterioration? A rigid plan without this feedback cannot reflect the different ways symptoms develop.

Footwear, temporarily reducing strain or other aids may be considered where appropriate. They do not, however, automatically replace rebuilding the tendon’s capacity. Whether physiotherapy guidance or another measure would be useful is determined by the findings and progress so far. Shockwave therapy may be discussed as an additional option for selected longer-standing symptoms. The evidence is not the same for every type of Achilles tendon problem. For ACP or PRP, the evidence for the specific form of Achilles tendon problem needs to be considered. It does not allow us to predict faster healing reliably for your individual situation. Before adding a treatment, its aim, alternatives and remaining uncertainty therefore need to be explained. Cortisone injection directly into the Achilles tendon is generally not recommended because it can increase the risk of tendon rupture.

Progress is often assessed over weeks and months. The diagnosis alone cannot establish a fixed recovery time. A specific goal helps, such as being able to walk a certain distance again or use stairs more confidently. One good exercise session does not yet mean that you can tolerate every previous activity again. If progress does not follow the expected course, the assessment should be reviewed. This is particularly important if there is marked new weakness, a sudden change or worsening symptoms. If significant limitations remain despite appropriate non-surgical measures, further specialist assessment may be useful. This does not automatically mean surgery.