What is the Achilles tendon?
The Achilles tendon is found at the back of the lower leg, just above the heel. It attaches your two calf muscles (gastrocnemius and soleus) to your heel bone (calcaneus) allowing you to push up onto your tiptoes. It therefore takes a lot of stress when you walk.
What is Achilles tendinopathy?
Achilles tendinopathy is a common condition that usually occurs when the tendon is unable to adapt to the strain being placed on it for example with a sudden increase in activity such as running, jumping or standing for long periods.
Symptoms include:
- Pain
- Stiffness and swelling at the back of the heel
- The tendon might be warm and tender to touch
- The tendon might be red, swollen or thickened in appearance
How is Achilles tendinopathy diagnosed?
A doctor or physiotherapist will normally diagnose Achilles tendinopathy by asking questions and examining you. X-Rays and scans are not usually needed.
Causes of Achilles tendinopathy
The cause of Achilles tendinopathy is not completely understood, however, there are certain factors which may increase the load being put through the tendon which may increase your risk including:
- Age: The condition is more common from the age of 30
- Gender: It is more common in men
- Diabetes: People with diabetes have a higher risk of developing Achilles tendinopathy
- Weight: Being overweight increases the risk of developing Achilles tendinopathy
- Tight and/or weak calf muscles
- Stiff ankle joints
- Poor lower limb alignment due to poor core stability around the hip and knee
- A sudden increase in activity levels such as walking, running or playing sports
- Training errors, e.g. a lack of variety in training or too much hill running
- Old or poor quality footwear
How can I treat my Achilles tendinopathy?
- Ice – you can wrap ice in a towel and put it on the affected area for a maximum of 20 minutes to help reduce pain and swelling. Do not apply ice directly to the skin
- Pain relief – simple pain relief can be used for short-term pain relief
- Relative rest – it can help to reduce activities on your feet such as walking or running
- Footwear – wear supportive footwear rather than flat shoes
Exercises for Achilles tendinopathy
When you start these exercises and progress to the next stage you may experience an increase in your pain. This is normal and should soon settle, however, it is important that this pain should not go beyond what you perceive to be a 4 out of 10 on a scale of 0 – 10, ‘0’ being no pain and ‘10’ being the worst pain imaginable.
For each stage, starting at Stage 1, exercises should be done daily aiming for 3 sets of 15 repetitions. If your pain increases beyond 4 out of 10, you can reduce your repetitions or go back to the previous stage. If the pain persists, try resting for 2 to 5 days.
Stage 1 – Gastrocnemius
- Stand on both feet with your knees straight
- Transfer your weight onto your good leg and rise up onto your tiptoes
- Slowly transfer your weight across to your bad leg as pain allows and lower yourself down using your good leg for support
- Over time progress by transferring more weight from your good leg onto your painful leg until you can eventually lower just on your affected leg
Stage 1 – Soleus
- Stand on both feet with a slight bend in your knees
- As with the previous exercise, transfer your weight onto your good leg and rise up onto your tiptoes but keep your knees slightly bent
- Keeping both feet on the floor, transfer your weight across to your affected leg as pain allows and lower yourself down using your good leg for support keeping your knees bent
- Over time progress by transferring more weight from your good leg onto your painful leg until you can eventually lower just on your affected leg
When you no longer need support from your good leg to lower yourself down progress to Stage 2.
Stage 2 – Gastrocnemius
- Stand on both feet with your knees straight
- Rise up onto your tiptoes
- Transfer your weight across to your affected leg and lift your good leg off the floor
- Lower yourself down just on your affected leg
Stage 2 – Soleus
- Stand on both feet with your knees slightly bent
- Rise up onto your tip toes keeping your knees bent
- Transfer your weight across to your affected leg and lift your good leg off the floor
- Lower yourself down just on your affected leg keeping the knee bent
When you can manage the Stage 2 exercises comfortably, you can progress to Stage 3.
Stage 3 – Gastrocnemius
- Stand on a step with both heels over the edge and your knees straight
- Rise up onto your tiptoes
- Transfer your weight across to your affected leg and lower yourself down so your heel is lower than the step
Stage 3 – Soleus
- Stand on a step with both heels over the edge and your knees slightly bent
- Rise up onto your tiptoes
- Keeping your knees bent, transfer your weight across to your affected leg and lower yourself down so your heel is lower than the step
To progress these exercises further you can wear a rucksack with some weight in it to increase the load through the tendon.
Stretching Exercises
It is important to reduce any tightness in the Achilles tendon by stretching the gastrocnemius and soleus muscles. Repeat these stretches on both legs.
Gastrocnemius Stretch
- Use a wall for support
- Place the leg to be stretched behind you keeping your foot pointing forward and your knee straight
- Keep your heel on the floor and lean forwards until you feel a stretch in your calf muscle
- Hold the stretch for 30 seconds
Soleus Stretch
- Use a wall for support
- Place the leg to be stretched behind you keeping your foot pointing forward
- Bend both knees
- Keep your heel on the floor and lean forwards until you feel a stretch in your calf muscle
- Hold the stretch for 30 seconds
Time it takes to recover
Unfortunately, there is no quick cure for Achilles tendinopathy. Exercises are designed to gradually increase the stress going through the Achilles tendon as the pain and swelling improves. It is normal to have some periods of increased pain/flare-ups during your recovery.
Most people will return to their full activities without pain within 6 to 9 months of rehabilitation.
If your symptoms do not improve within this time (even after following an exercise programme), you may be referred back to your doctor for a review.
Any further questions, please contact your local site Physiotherapy department.
Physiotherapy Departments
County Hospital Louth: 01507 631234
Grantham District Hospital: 01476 464253
Lincoln County Hospital: 01522 573945
Pilgrim Hospital Boston: 01205 445494
Johnson Community Hospital Spalding: 01775 652204
Skegness and District Hospital: 01754 613516