Achilles Pain
Understand What May Be Causing Your Symptoms.
Achilles pain can have several different causes. Understanding which part of the tendon may be involved, how it is being loaded and why that load may have become difficult to tolerate is an important part of recovery.
60-90 Minute Specialist Assessment | £185
Not All Achilles Pain Is the Same
Achilles pain can have several different causes. Achilles tendinopathy is one of the most common, but it is not the only cause of pain around the back of the heel and ankle.
Achilles tendinopathy can affect different parts of the tendon. Mid-portion Achilles tendinopathy typically affects the tendon 2–6 cm above the heel, while insertional Achilles tendinopathy affects the area where the tendon attaches to the heel bone. Other problems can also cause pain around the back of the ankle and heel.
The location and behaviour of your symptoms can provide useful clues, but they do not always tell us exactly which tissue is responsible.Knowing which tissue is involved is the first step. However, understanding why the tissue has become overloaded is just as important.
Why Does Achilles Pain Develop?
Achilles pain can develop when the demands placed on the tendon exceed its current capacity to tolerate and recover from load.
This can be influenced by factors such as:
• A rapid increase in running volume
• Increased hill or speed work
• Reduced calf strength or endurance
• A sudden change in footwear
• Returning to sport after a break
• Insufficient recovery between sessions
These factors can interact, and what is relevant will vary from person to person.
Understanding what has increased the demand on the tissue is an important part of deciding what needs to change to support recovery.
What Can You Do to Help?
Managing the load on your Achilles tendon can help settle symptoms and create the conditions for recovery.
• Temporarily reduce activities that significantly aggravate your pain.
• Keep active at a level your symptoms can tolerate.
• Gradually increase activity as your symptoms improve.
• Address relevant calf strength or capacity limitations.
• Consider whether your footwear is appropriate.
• Allow adequate recovery between loading sessions.
Our guide to Achilles tendinopathy provides more detailed advice on understanding and managing Achilles pain.
The guide is a useful starting point for managing your symptoms. If your symptoms persist, worsen or do not respond as expected, further assessment may be needed to understand what is contributing to your pain.
How Is Achilles Pain Assessed?
Understanding the cause of your symptoms requires more than identifying where the pain is felt.
An assessment considers your symptoms alongside the tissues that may be involved and the factors that could be contributing to their overload.
Clinical Assessment
Your history, symptoms, palpation and relevant clinical tests help identify the structures involved.
Movement & Capacity
Strength, mobility and functional testing help assess how your foot and lower limb tolerate load.
Gait & Loading Analysis
Where relevant, video gait analysis and pressure mapping provide further information about how load is being applied.
The findings are brought together to understand which tissue is involved, why it may be overloaded and what needs to change.
How Can Achilles Pain Be Treated?
Treatment depends on what is contributing to your symptoms. There is no single treatment that is appropriate for every cause of Achilles pain.
Your Recovery Plan may include:
Load Modification
Adjusting activity to bring the demands on the affected tissue within its current capacity.
Rehabilitation
Building strength, mobility and tissue capacity where these are relevant to the problem.
Footwear
Considering footwear characteristics that may help manage symptoms and loading.
Orthoses
Where appropriate, orthoses can modify how load is distributed through the foot and reduce demand on an affected tissue.
The aim is to address both the symptoms and the factors contributing to the problem.
When Might an Assessment Help?
An assessment may be useful if:
- Your symptoms have persisted despite self-management.
- Your pain returns when you increase activity.
- You are unsure what is causing your symptoms.
- Previous treatment has not fully resolved the problem.
- You want to understand what is contributing to your symptoms and what needs to change.
The aim is to identify the factors contributing to your symptoms and develop a clear plan for recovery.