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- info@physio-soton.co.uk
- 297 High Street, Eastleigh, SO50 5NB
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Achilles tendon treatment works best when you know exactly what is wrong first. At Physio Soton in Eastleigh we assess your tendon, scan it in the same appointment when imaging would help, and build a loading programme around what the scan actually shows. That matters because Achilles pain behaves differently depending on where it sits, how long it has been there, and whether the tendon itself or the tissue around it is the problem.
If you have pain at the back of your heel, stiffness in the first steps of the morning, or a tendon that feels thickened and sore after running, you are in the right place. Below you will find what causes it, how we treat it, the two loading programmes with the strongest evidence behind them, and when a scan or an injection genuinely adds value.
The Achilles is the strongest and longest tendon in the body. It connects your two calf muscles, the gastrocnemius and the soleus, to your heel bone, and it provides around 93 per cent of the force that pushes you off the ground. It is also one of the most frequently injured tendons in the body, accounting for roughly 9 per cent of general sports injuries and up to 18 per cent of running injuries.
Most Achilles pain comes down to load. The tendon did too much work in too short a time, or the way it works changed. A new training block, more hills, a switch to road running, different footwear, or a sudden jump in distance will all do it. Tendons dislike sudden change.
There is often a warning period. Many people have low-grade discomfort for weeks or months before the tendon really complains. If you injured the other leg recently, an ACL tear or a hamstring strain for example, Achilles pain on the opposite side is common because you have been loading that leg harder to compensate.
Mid-portion tendinopathy affects the tendon two to six centimetres above the heel bone. Insertional tendinopathy sits right where the tendon attaches to the calcaneus. This distinction changes your rehab.
Insertional problems are usually irritated by compression, which means exercises performed over the edge of a step can make things worse rather than better. Getting this wrong is one of the most common reasons a loading programme fails.
Several structures sit close enough to mimic Achilles pain. The plantaris tendon runs parallel to the Achilles and can produce pain in the same spot, particularly on the inner side. Achilles bursitis, an irritated Kager’s fat pad, and Haglund’s deformity all present around the same area. Pain underneath the heel rather than behind it usually points towards plantar fasciitis instead.
This is precisely where a scan earns its keep. If a loading programme has not worked, there is a reasonable chance the problem was never quite what everyone assumed.
Tendinopathy is a painful but intact tendon. It builds gradually and hurts more with load. A rupture is a tear, and it feels different. People describe a sudden snap or a sensation of being kicked in the back of the leg, followed by an inability to push off properly.
If you suspect a rupture, treat it as urgent. Point your foot downwards so the heel sits lower than the toes, put a wedge or heel raise under the heel, use crutches, and get seen within 48 hours. Early treatment gives you the best chance of restoring full function. Full guidance is on our Achilles rupture page, including boot fitting and recovery timelines.
Not always, but often more than people expect. Many cases are diagnosed clinically. A scan becomes genuinely useful when the diagnosis is unclear, when rehabilitation has stalled, or when you want to know what you are dealing with before committing months to a programme.
A diagnostic ultrasound scan shows the tendon insertion, the paratenon, Kager’s fat pad and the surrounding bone surface. It measures tendon thickness in two planes so swelling can be tracked over time. Power Doppler shows whether new blood vessels have formed inside the tendon, which matters because those vessels carry nerve endings and can be a genuine source of pain. It is quick, involves no radiation, and you get answers during the appointment rather than waiting for a report.
MRI is also accurate and is usually reserved for cases where surgery is being considered. It costs considerably more and requires a hospital visit. Where MRI is genuinely needed, we refer to a private provider.
Ultrasound also picks up less common findings. This clip shows calcium deposits within the Achilles tendon, one of the rarer causes of pain we occasionally find on scanning
Achilles tendon treatment starts with an assessment, not a protocol. You will get a full history and a hands-on examination first. We look at where the pain sits, how the tendon responds to load, your calf strength, your ankle range, and what changed in your training or daily activity before symptoms started.
If imaging would change the plan, we can scan in the same visit. You see the images, and we explain what they show. You leave with a diagnosis, a loading programme matched to your specific presentation, and a clear idea of the likely timeframe. No GP referral is needed to book.
Every effective Achilles tendon treatment plan is built on one principle. Load is the primary stimulus that drives a tendon forwards or backwards along the continuum. That principle, from Cook and Purdam, sits behind everything below. Rest alone does not fix tendons. Progressive loading does.
When the tendon is highly irritable, eccentric and isotonic work is often too much. Isometrics let you load the tendon without movement.
Level A: stand on tiptoes on both legs for 45 seconds. Five repetitions with two-minute breaks between each.
Level B: the same, with all your weight through the painful leg only.
Level C: add load by pushing up against a door frame while you hold the position.
Run this daily for four to six weeks, then progress. Research by Gatz and colleagues found that isometrics add little once you can tolerate other loading, so treat them as a starting point rather than a destination.
A four-phase programme running from the first week through to six months.
Phase 1, weeks 1 to 2. Once daily. Double leg calf raises on the floor, 3 sets of 10 to 15. Single-leg calf raise on the floor, 3 sets of 10. Seated calf raise, 3 sets of 10. Eccentric calf raise on the floor, 3 sets of 10, rising on two feet and lowering on one.
Phase 2, weeks 2 to 5. Once daily. The same movements performed on the edge of a step, 3 sets of 15. Add quick rebounding double-leg calf raises, 3 sets of 20, moving fast without the toes leaving the floor.
Phase 3, weeks 3 to 12. Once daily, with a heavier session two or three times weekly. Add weight through a backpack or a machine. Progress quick rebounding raises towards single leg. Introduce plyometrics under supervision, building to 3 sets of 20.
Phase 4, week 12 to 6 months. Maintenance, two or three times weekly, continued until symptoms have fully settled.
A twelve-week protocol. Stand with the balls of your feet on a step, heels hanging over the edge, holding a rail for balance. Keep your knees straight to load the gastrocnemius. Rise on both feet, transfer to the painful leg, then lower slowly so the heel drops below the step.
Return to two feet and repeat. Three sets of 15, then repeat the whole sequence with knees bent to load the soleus. Twice daily.
Both produce comparable outcomes. The right choice depends on your presentation, and this is where insertional tendinopathy matters again, because step-based exercises load the tendon into compression. If your pain sits at the insertion, those exercises may need modifying or removing.
Speak to a physiotherapist before starting, and if pain is acute, you may need a week or two of relative rest, or a boot, before loading begins. For a well-structured NHS reference programme you can read alongside this, the Royal National Orthopaedic Hospital’s Achilles tendinopathy guide is genuinely useful and freely available.
Evidence supports shockwave for mid-portion Achilles tendinopathy that has not responded to a proper loading programme. It reduces pain and improves function, and the best results come from combining it with continued loading rather than using it alone. It works as part of your wider Achilles tendon treatment plan rather than as a replacement for rehab. More detail on our shockwave therapy page.
A high volume injection places saline and local anaesthetic into the space between the tendon and its sheath, stripping away the neovascularisation that can drive pain. It suits patients whose Power Doppler scan shows a high degree of vascularity, which is exactly why we check for this during scanning. More than half of suitable patients respond well.
Fenestration works differently. Under ultrasound guidance and local anaesthetic, a needle passes through the abnormal tendon repeatedly, converting a stubborn chronic problem into an acute one that the body is more likely to heal.
Steroid calms inflammation effectively and has a genuine role in many joints, which is why we offer ultrasound-guided steroid injections elsewhere in the body. The Achilles is different. Steroid degrades collagen, and in a weight-bearing tendon that already has poor blood supply, that raises rupture risk. We do not do it, and you should be cautious of anyone who offers it.
Platelet-rich plasma is also worth mentioning, honestly. A University of Warwick study found no difference between PRP and sham injections for Achilles tendinopathy. It has value in other conditions. Here, the evidence does not support it.
Where calf tightness and trigger points are feeding into the problem, dry needling can reduce pain and improve ankle range enough to let you engage properly with your loading programme.
Usually yes, at a reduced level. Stopping entirely is rarely part of good Achilles tendon treatment, because complete rest tends to weaken the tendon further and slow your recovery. The aim is to train at the highest level the tendon tolerates without flaring symptoms, then rebuild volume gradually.
A practical rule many clinicians use is that pain during and after a run should stay low and settle within 24 hours. If it does not, the load was too high for that day. Some people need a temporary break from running while the tendon settles. Cycling and swimming keep fitness ticking over in the meantime.
Stretching is the part of Achilles tendon treatment people abandon once the pain settles, which is exactly why problems return. With age the Achilles becomes stiffer and shorter, and heeled shoes do not help. Regular stretching keeps it functional and prevents recurrence.
Use a step or a stair with a bannister. Place the balls of your feet on the edge and let the heels drop. Build the hold gradually week by week, starting at 15 seconds three times a day in week one, doubling to 30 seconds in week two, then one minute, and continuing to build towards three minutes by week seven. A slant board makes this easier to control if you prefer.
Heel pain in an eight to fourteen year old is more likely to be Sever’s disease than a tendon problem. It affects the growth plate at the back of the heel bone rather than the tendon itself, and it typically worsens with sport rather than easing once warmed up, which is the opposite of adult tendinopathy. It responds well to activity modification, heel support and physiotherapy. An ultrasound scan helps confirm it.
Marek Czeladzki is a chartered physiotherapist registered with the HCPC and CSP, an independent prescriber, and a musculoskeletal sonographer who is a member of both the British Medical Ultrasound Society and the American Institute of Ultrasound in Medicine. He also completed intensive studies in myoskeletal therapy and treats spinal, joint and muscle injuries including sports injuries. A diagnostic ultrasound scan forms part of the initial assessment where clinically appropriate, so your Achilles tendon treatment is guided by what the tendon actually looks like.
Tendons are slow. Expect months rather than weeks, and in stubborn cases up to a year for full resolution. Pain often improves well before the tendon has fully recovered, which is exactly when people return to sport too early and relapse.
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Tendinopathy is the accurate term. There is little genuine inflammation involved in most chronic cases, which is why anti inflammatory tablets often disappoint and why loading matters more than icing.
Not necessarily. A scan is most valuable when the diagnosis is uncertain, when progress has stalled, or when a partial tear is suspected.
It can ease calf tightness that contributes to the problem, but massage alone will not resolve tendinopathy. Loading does that.
That is worth investigating rather than persevering indefinitely. It may be insertional rather than mid-portion; the plantaris may be involved, or the diagnosis may need revisiting with a scan.
Sometimes. A meaningful proportion of chronic cases eventually require surgical input, which is why getting the diagnosis and the loading right early genuinely matters.
If your Achilles pain has lasted more than a few weeks, is not responding to exercises, or you simply want to know what is actually going on before you commit to months of rehab, book an assessment. We will examine the tendon, scan it if that would change the plan, and give you a programme built around your specific presentation.
No GP referral is needed. Call 023 8218 2416 or book online. You can also read more about physiotherapy at our Eastleigh clinic, which serves patients across Southampton, Chandler’s Ford, Winchester, Romsey and the wider Hampshire area.
Our approach to Achilles tendon treatment is based on published research. These are the main sources behind the guidance on this page.
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