Achilles Tendinopathy - Understanding and Treatment
1. What is mid-portion Achilles tendinopathy?
It is a condition where the central part of the Achilles tendon (about 2–6 cm above the heel) becomes painful and thickened due to overuse or degeneration.
2. What causes mid-portion Achilles tendinopathy?
It is typically caused by repetitive strain, overuse, or a sudden increase in activity, especially in sports involving running or jumping.
3. What are the symptoms?
Common symptoms include pain and stiffness in the tendon, especially in the morning or after exercise, and sometimes visible thickening of the tendon.
4. Who is at risk?
Runners, athletes, people who increase training too quickly, and individuals with tight calf muscles or poor ankle mobility are more prone to this condition. Obesity is an important risk factor too.
5. Is it an inflammatory condition?
No. While it was once thought to be due to inflammation ('tendonitis'), it is now understood as a degenerative condition with minimal inflammation. This is why anti-inflammatory painkillers seldom help.
6. How is it diagnosed?
Diagnosis is usually clinical, based on history and physical examination. Imaging such as ultrasound or MRI is used only in unclear or persistent cases.
7. Can mid-portion Achilles tendinopathy heal on its own?
It often requires active rehabilitation. Rest alone is usually not effective and can even prolong recovery.
8. What is the most effective treatment?
Calf stretching using a slant board is advised. A structured program of eccentric or heavy slow resistance exercises has the strongest evidence for improving tendon health – but for some patients these exercises are 'too strong'.
9. What are eccentric exercises?
Eccentric exercises involve lengthening the muscle-tendon unit under load—such as lowering the heel slowly after rising on your toes.
10. How long does recovery take?
Recovery typically takes 3 to 6 months or more, depending on the severity and consistency of rehabilitation.
11. Should I stop running or exercising?
You may need to reduce high-impact activities initially. However, staying active with modified, low-load exercises is encouraged.
12. Do I need a scan like an MRI or ultrasound?
Not usually. Imaging is reserved for persistent or unclear cases, or if a tear or other condition is suspected.
13. Can stretching help?
Gentle calf stretching can help improve flexibility and a slant board is an excellent way to do this.
14. Is massage or foam rolling beneficial?
These techniques may relieve surrounding muscle tension and soothe, but are no substitute for stretching or tendon-loading exercises.
15. What kind of footwear is recommended?
Supportive shoes with good cushioning and slight heel elevation helps reduce tendon strain during daily activities.
16. Are heel lifts or orthotics useful?
Yes, temporary use of heel lifts may reduce strain on the tendon. Orthotics may be beneficial in some individuals with specific foot mechanics.
17. Do anti-inflammatory medications help?
They are generally not useful ('wrong kind of inflammation') but may offer short-term symptom relief. They do not address the underlying tendon pathology.
18. Is corticosteroid injection recommended?
No, corticosteroid injections are generally not advised for this condition due to the risk of tendon weakening or rupture.
19. Can it recur?
Yes, especially if rehabilitation is incomplete or training loads increase too quickly. Ongoing stretching, strength maintenance and load management are key.
20. Do I have to stretch forever?
Yes. To prevent recurrence, stretching is a life-sentence.