Achilles Tendonitis: Understanding, Treating, and Recovering
What Is Achilles Tendonitis and How Does It Occur?
Often called Achilles tendinitis or tendinopathy, this condition refers to pain, stiffness, and degeneration of the Achilles tendon—typically located between 2–6 cm above the heel (mid‑portion, ~55–65% of cases) or at its insertion to the heel bone (insertional, ~20–25%).
It usually arises from overuse and repetitive strain, leading to maladaptive tissue changes rather than classic inflammation. Activities like long-distance running, jumping, or sudden load increases are common drivers. Risk factors include poor footwear or training surface, biomechanical issues (e.g., excessive foot pronation), family history (up to 5× higher risk), and medical conditions like hypertension, diabetes, or certain medications (e.g., fluoroquinolones).
UK Incidence & Healing Timeframes
In the UK, around 4,500 people seek medical help for Achilles tendinopathy each year, equating to an annual incidence of approximately 18 per 100,000 population.
Recovery typically occurs within 2–3 months, with about 80% of patients achieving full recovery within 3–6 months.
In the general UK population, estimates suggest that over 300,000 people annually experience Achilles tendinopathy symptoms.
The Central Role of Physiotherapy
Physiotherapy is the cornerstone of effective treatment—focusing on tendon-loading strategies rather than stretching alone.
Key objectives of physiotherapy include:
Reducing pain and improving function through structured loading.
Correcting biomechanical issues like poor foot alignment or training errors.
Rebuilding tendon strength and flexibility gradually.
Most Common and Effective Exercises
A standout approach is the Alfredson Eccentric Heel-Drop Protocol—one of the most widely accepted rehab routines for Achilles tendonitis:
3 sets of 15 reps, twice daily, straight and bent-knee heel drops, over 12 weeks.
Targets increased tendon strength and promotes healing.
Additional supportive exercises include:
Calf raises (progressive, weight-based).
Heel raises on a step to allow a full stretch.
Balance and proprioception drills to enhance tendon loading tolerance.
When Injections or Surgery Become Necessary
Injection Therapies
Corticosteroid injections are generally not recommended for Achilles tendinopathy—they provide short-term relief but may weaken the tendon and increase rupture risk.
Evidence for PRP (platelet-rich plasma), autologous blood injections, and similar treatments is limited and inconclusive.
Some novel treatments—like sclerosing injections, hydro‑tenotomy, or shockwave therapy—show tentative benefit in refractory cases.
Surgery
Reserved for persistent cases where conservative rehab (12 months+) fails or when structural tendon damage is significant. Common surgical options include:
Debridement of degenerative tendon tissue.
Gastrocnemius recession to reduce tendon stress.
Surgical results are generally positive: up to 75% return to pre-surgical activity levels, with 90% patient satisfaction. Full recovery often takes up to 12 months, and 20–30% may experience lingering pain post-op.
Final Thoughts
Achilles tendonitis is a common, often debilitating condition—but with the right intervention, most individuals recover well. A structured physiotherapy program, particularly one focused on eccentric loading, is the proven first-line treatment. Conservative recovery timelines span a few months, with full recovery usually achieved by 6 months. For stubborn cases, less-validated injections may offer relief, and surgery remains a reliable option when all else fails.