Achilles pain tends to sneak up on you. A bit of stiffness at the back of the heel first thing, an ache at the start of a run that warms up and disappears, and then one day it doesn’t. It’s common in runners, in people who have just stepped up their walking or sport, and from midlife onwards, when tendons become less forgiving of sudden changes. It often responds well to a structured strengthening programme, and most people can stay active while it recovers.
Does this sound familiar?
- Pain or stiffness in the tendon just above the heel, or where it joins the heel bone
- Stiffness first thing in the morning or after sitting, easing as you move
- Pain at the start of a run or walk that warms up, then returns afterwards or the next day
- A thickened or tender area when you squeeze the tendon
- Pain going up stairs or hills, or rising onto your toes
What's usually going on
Achilles tendinopathy happens when the tendon is asked to do more than it’s ready for, often after a jump in running mileage, more hills or speed work, a new sport or a change of shoes. Rather than being torn or inflamed, the tendon becomes sensitive and its structure changes a little, and it needs to be loaded gradually to recover.
There are two main types. Mid-portion tendinopathy is a few centimetres above the heel. Insertional tendinopathy is where the tendon joins the heel bone, and it needs a slightly different approach, particularly with stretching, which can aggravate it. Working out which one you have shapes the plan.
Some antibiotics, called fluoroquinolones (ciprofloxacin is one), are linked to tendon problems. If you’ve taken one recently, tell your GP and tell us.
What can help
- A progressive strengthening programme for the calf and Achilles, usually over at least 12 weeks. This is the core of treatment and has the strongest evidence behind it.
- Managing the load, so you keep running, walking or playing at a level the tendon can tolerate rather than stopping completely.
- A gradual return-to-running plan, with clear rules for when to build up and when to hold.
- Footwear advice and sometimes a temporary heel raise, which can take some strain off an insertional tendon.
- Medical acupuncture, which we use often for Achilles problems alongside the strengthening programme. Many people find it eases the pain while the exercises do their work, and most find it very tolerable.
- Hands-on treatment to ease pain and stiffness around the calf and ankle.
Steroid injections aren’t recommended for the Achilles tendon because of the risk of weakening it. If you’re not improving after a good spell of rehab, we’ll talk through the next steps with you and, where needed, your GP.
Your first appointment
Your first appointment lasts 45 minutes, with one of our chartered physiotherapists. We’ll ask how it started, what your training or activity has looked like over the last couple of months and what you want to get back to. Then we’ll examine the tendon, test your calf strength and ankle movement, and look at how you walk, hop or run. Bring your trainers, and your training log if you keep one.
You’ll leave with a diagnosis, a starting set of exercises and a clear idea of how much activity is sensible for now. Tendons are slow to change, so this is one where steady, regular progression matters more than lots of appointments. Most people come back every two to three weeks to move the programme on.
When to get urgent help
- A sudden snap, or the feeling of being kicked in the back of the leg, followed by difficulty walking or standing on tiptoe. This can be an Achilles rupture and needs to be seen at A&E the same day.
- Calf pain with swelling, warmth or redness, especially after a long journey, an operation or a spell of being immobile. See a doctor the same day to rule out a blood clot.
- Tendon pain that started soon after taking a fluoroquinolone antibiotic. Speak to your GP or pharmacist straight away.
- A hot, swollen tendon with a temperature or feeling generally unwell.
Prices and insurance
- Initial assessment and treatment (45 minutes): £79
- Follow-up treatment (30 minutes): £64
No GP referral is needed. You pay at your appointment and we’ll give you an invoice to claim back from your insurer if you’re covered. Many of our clinicians are recognised by AXA, Aviva, BHSF, Cigna, Simplyhealth, Westfield Health and WPA. Recognition varies by clinician, so ask us when you book.
Frequently asked questions
Questions we’re often asked about Achilles tendon pain.
- Should I stop running?
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Most people don’t need to stop completely. Running is usually fine if the pain stays mild during the run and has settled by the next morning. If it’s worse the next day, that’s a sign to cut back for a while.
- Should I stretch my Achilles?
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Gentle calf stretching is fine for many people with mid-portion pain, but stretching hard into the heel can aggravate insertional tendinopathy. For both types, strengthening matters more than stretching.
- How long does it take to get better?
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Tendons adapt over months rather than weeks, so a programme usually runs for at least 12 weeks, and longer if the problem has been around for a while. Most people find the tendon gradually becomes more tolerant along the way.
- Do you offer shockwave therapy?
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No. For Achilles pain that’s slow to settle, our physiotherapists usually add acupuncture to the strengthening programme, and most people find it very tolerable. If we think another treatment would suit you better, including one we don’t offer, we’ll tell you.
- Will I need a scan?
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Usually not. Achilles tendinopathy is diagnosed from your history and an examination. We’ll recommend a scan if we suspect a tear or something else, or if you’re not progressing as expected.
- Is it the same as plantar fasciitis?
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No, although they sometimes turn up together. Plantar fasciitis is pain under the heel, while Achilles pain is at the back of the heel or just above it. Our page on heel pain and plantar fasciitis covers that one.
- Do I need a GP referral?
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No, you can book directly. If you’re claiming on private health insurance, check whether your insurer needs a GP referral first.
Based in Haywards Heath, we see patients from:
You’ll find us at Unit 3, 2-8 Sussex Road, Haywards Heath, RH16 4EA. There’s free on-street parking on Sussex Road and two pay and display car parks a short walk away, and our entrance, treatment rooms and toilets are wheelchair accessible. We’re open Monday to Friday 8am to 7pm, and Saturday 8am to 1pm.
Book an appointment
If your Achilles has been sore for more than a couple of weeks, or it’s getting in the way of running or walking, it’s worth having it looked at. Book online or call us on 01444 817851.
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