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Home » Conditions » Achilles Tendinopathy: Symptoms, Causes and Treatment

Whether you’re a keen runner, a weekend walker, or someone who’s just started noticing pain near the back of your ankle, Achilles tendinopathy is a condition that can affect people of all activity levels. It’s frustrating, persistent, and if left untreated, can limit your mobility for months. The good news? There are effective, evidence-based treatments – including MSK injections — that can help.

What is Achilles Tendinopathy?

Achilles tendinopathy is a condition that affects the Achilles tendon – the thick, strong band of tissue that connects your calf muscles to your heel bone. It’s responsible for helping you walk, run, jump and rise onto your toes.

Tendinopathy refers to degenerative changes within the tendon, often caused by overuse or repetitive strain. Unlike tendonitis (which is more about inflammation), tendinopathy typically involves microscopic damage and thickening of the tendon structure. 

It can be:

  • Mid-portion tendinopathy: Pain located 2–6 cm above the heel
  • Insertional tendinopathy: Pain where the tendon attaches to the heel bone

What Causes Achillies Tendinopathy?

Achilles tendinopathy often develops gradually, and is commonly caused by:

  • Sudden increases in activity or intensity (e.g., running or jumping)
  • Poor footwear or biomechanics
  • Tight calf muscles or limited ankle mobility
  • Repetitive strain without enough rest or recovery

Although it’s most common in runners and athletes, it can also affect less active individuals -especially those with jobs that involve standing or walking for long periods.

Symptoms to Watch For

  • Pain and stiffness in the back of the ankle, especially in the morning
  • Tenderness and swelling along the tendon
  • Pain that worsens during or after activity
  • Thickening of the tendon
  • Difficulty pushing off the foot or rising onto toes

If these symptoms persist for more than a few weeks, it’s important to seek assessment early — the longer the condition is left untreated, the more stubborn it can become.

Standard Treatment Options

Initial treatment for Achilles tendinopathy is conservative, with a strong emphasis on activity modification and rehabilitation.

  • Load Management Reducing/Modifying. Reducing or modifying the activity that aggravates your pain is key. This doesn’t mean total rest – in fact, controlled movement is important – but avoiding high-impact activity while gradually reintroducing load is vital.
  • Physiotherapy & Strengthening Exercises. Rehab exercises (especially eccentric calf loading, like slow heel drops) are a cornerstone of recovery. These exercises help improve tendon structure, build load tolerance, and reduce pain and stiffness over time.
  • Manual Therapy. Some people benefit from hands-on techniques such as massage, dry needling, or joint mobilisation, especially if there are contributing factors like tight calves or limited ankle range.
  • Extracorporeal Shockwave Therapy (ESWT). ESWT uses sound waves to stimulate the healing process in the damaged tendon tissue, potentially reducing pain and improving tendon function.
  • Orthotics or Footwear Changes. Supportive footwear and, in some cases, custom insoles can help offload pressure from the tendon and improve overall biomechanics.

MSK Injections: When and How They Help

For cases that don’t respond fully to rehab, or when pain is limiting progress, musculoskeletal (MSK) injections can be a valuable part of a comprehensive treatment plan. These targeted interventions can help reduce pain and inflammation, improve mobility, and facilitate greater participation in rehabilitation.

High-Volume Saline Injections (HVIGI):

Carried out with ultrasound guidance, this technique involves injecting a large volume of saline, often combined with a local anaesthetic, around the Achilles tendon.  The goal is to disrupt abnormal neovascular tissue that contributes to pain. HVIGI is particularly useful for mid-portion tendinopathy and can support better engagement with rehab exercises.

Prolozone Injections

Prolozone therapy combines the regenerative potential of ozone gas with injectable nutrients. It is designed to reduce inflammation, improve oxygen utilisation in tissues, and stimulate natural healing processes. For Achilles tendinopathy, prolozone can offer an alternative option for pain relief and tendon support, especially when other therapies are limited or contraindicated.

Corticosteroid Injections

Steroid injections are generally avoided in mid-portion Achilles tendinopathy due to the potential risk of tendon weakening or rupture. However, they may occasionally be used with caution in cases of insertional tendinopathy, particularly where bursitis or significant local inflammation is present. These injections must always be guided by imaging and tailored to the individual.

Treatment for Severe Cases

If conservative treatments are not successful, surgery may be necessary. This could involve debridement (removal of damaged tissue), tendon transfer (using a healthy tendon from another part of the leg), or other procedures to repair or reinforce the Achilles tendon.

Achilles tendinopathy can be persistent and frustrating, but with the right approach, it’s very treatable. Early intervention, structured rehab, and the appropriate use of MSK injections can all help get you back to moving confidently and pain-free.

If you’re experiencing ongoing Achilles pain, don’t wait it out. Book a consultation to explore your treatment options and get a personalised plan that works for you.

Private Injection Clinics offers the above injections to treat many different MSK related pains – including Achillies tendinopathy.  For more information please take a look at our website.

Private Injection Clinics are based on the coast in Leigh on Sea and in Colchester, Essex – perfect for patients in Essex, Kent, London, and surrounding areas.

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