The Achilles tendon is located at the back of your calf (the back of the lower part of your leg) and connects these muscles to the heel bone. Its main function is to help you to push up on your tiptoes. Achilles tendinopathy is an overload injury to this tendon. The tendon suffers small tears which do not repair as well as they should, causing pain.

The typical symptoms include pain, stiffness and swelling of the back of the heel. Pain is often present first thing in the morning or when you begin to walk after resting for a period of time. You may notice the pain worsens after intense activities like walking or running. In some cases, the tendon may become warm, tender to touch and swollen in appearance.

The causes of Achilles tendinopathy are not fully understood, but there are many factors that can contribute to it, including:

• Overweight

• Tight or weak calf muscles

• Stiff ankle joints

• Sudden increase in activity levels, for example, running, walking, playing sports

• Poor training planning, such as excessive hill running

• Mal-alignment of the lower limbs

• Medication

• Metabolic disorders

To reduce pain in the short term you can try the following:

• Reduce activities on your feet such as prolonged walking or running. Non-contact activities like cycling or swimming are recommended

• Analgesics may be used to provide short term pain relief

• Ice: applying ice for 10 min every 3 hours, wrapped in a towel, can help with pain and swelling in the early stages

• Choosing supportive footwear, rather than flat shoes can help in relieving pain

Diagnosis is confirmed by taking a medical history of the patient and completing a physical examination. X-rays, Ultrasound and MRI are requested to further assess the condition.

As Achilles tendinopathy is related to the ability of the tendon to cope with load, exercises specific to strengthening this tendon will help healing and return to activity. You will need to follow a physiotherapist’s instructions and monitor your performance carefully. Exercises specific to the tendon are needed to help recovery, but overloading the tendon may worsen the pain.

For most people, it will take six to nine months of focused rehabilitation to make a return to full activities without pain. It is normal to have some periods of increased pain or flare-ups during your recovery. If your symptoms don’t improve within six to nine months, even when you have been completing an appropriate exercise programme, other treatment options, such as Shockwave therapy or Platelet Rich Plasma may be considered. Surgery might be an option and it is analysed case by case. This would involve making small cuts to enhance tendon healing response.