Achilles tendonitis (Achilles tendinopathy) is best treated with a structured loading programme, such as heel-drop exercises, for at least 12 weeks. The classic Alfredson eccentric programme (1998) became a standard because most patients returned to activity. Shockwave can add benefit. A well-known trial in JAMA (de Vos, 2010) found PRP was no better than saline when added to exercise for chronic mid-portion Achilles tendinopathy.
Symptoms
- Pain and stiffness at the back of the heel, worse in the morning
- Pain at the start of activity that may ease, then return after
- A thickened, tender tendon
Tendon pain for more than 3 months? Get the free guide and a doctor review of your scan.
Treatment
- Loading exercises daily for 12 weeks
- Reduce, do not stop, aggravating activity
- Heel lifts in shoes short term
- Shockwave therapy if progress stalls
- Injections: avoid cortisone into the Achilles (rupture risk); PRP or stem cells for persistent cases, with realistic expectations
Sudden snap?
A pop and inability to push off suggests a rupture: see a doctor the same day. See when surgery is needed.
Who gets Achilles tendinopathy
Runners and court-sport players, people who suddenly increase activity, and adults over 40. Higher risk with tight or weak calves, flat feet, diabetes, high cholesterol and fluoroquinolone antibiotics.
Tendon pain for more than 3 months? Get the free guide and a doctor review of your scan.
Mid-portion vs insertional
| Type | Where it hurts | Key tip |
|---|---|---|
| Mid-portion | 2 to 6 cm above the heel | Heel drops off a step |
| Insertional | Where the tendon meets the heel bone | Heel drops on flat ground; avoid stretching into dorsiflexion |
Treatment options
- Stem cell injection for stubborn tendinopathy: minimally invasive, helps the tendon rebuild
- 12-week loading programme
- Shockwave therapy
- Heel lifts and footwear changes
- Surgery only for ruptures or rare cases
Recovery time
Most people improve within 3 to 6 months of consistent loading. Long-standing cases may take longer, which is where regenerative treatment is most often considered.
Common questions
Should I stop running? Usually reduce, not stop. Keep pain during and after runs mild.
Is cortisone safe for the Achilles? It is generally avoided because of rupture risk.
