Achilles Tendinopathy
The Achilles is the largest tendon in the body — and one of the most commonly injured.
Diagnostic ultrasound on-site to confirm whether you have tendinosis, partial tear, or paratenonitis — because each requires different treatment.
Mid-portion vs insertional — different conditions, different treatment
Achilles tendinopathy is degeneration of the Achilles tendon caused by repetitive load that exceeds the tendon's capacity to recover. It comes in two main forms:
- Mid-portion tendinopathy — pain and thickening 2–6cm above the heel insertion. Most common form. Responds well to progressive loading rehab.
- Insertional tendinopathy — pain at the heel where the tendon attaches to the calcaneus. Often associated with a Haglund's deformity. Treatment differs meaningfully — lifts and footwear modification matter more, aggressive stretching can worsen it.
On top of this, ultrasound may reveal partial tears, intrasubstance splits, or fluid in the paratenon (paratenonitis) — each of which changes the treatment plan.
Common symptoms
Imaging changes the plan
Treating Achilles pain without imaging is guesswork. Loading protocols suitable for a tendinosis can be the wrong choice for a partial tear. Stretching that helps mid-portion tendinopathy can aggravate insertional disease.
Our Diagnostic Injury Assessment includes on-site MSK ultrasound — we visualise the tendon directly to confirm the diagnosis and stage. We then build a loading programme that matches both the tissue state and your activity goals.
Diagnostic Injury Assessment
45 minutes · €160. Includes ultrasound imaging of the Achilles tendon, gait analysis, and a defined treatment pathway.
How we treat Achilles tendinopathy
Progressive Loading Rehab
Heavy slow resistance and eccentric loading remain the most evidence-based intervention for tendinopathy. We build a programme matched to your stage and goals.
Heel Lifts / Custom Orthotics
Particularly important for insertional disease. Heel raises reduce tension at the insertion. Custom orthotics where biomechanics are loading the tendon asymmetrically.
Activity Modification
Specific guidance on training load — not 'rest', but managed reduction in aggravating loads while loading is reintroduced therapeutically.
Injection Therapy / Shockwave
For chronic cases that haven't responded to loading rehab, ultrasound-guided injection therapy or shockwave can be considered.
Frequently asked questions
Can I keep running with Achilles tendinopathy?
Often yes, but with managed load. Tendons respond to progressive loading — complete rest is rarely the right answer. We'll give you a specific running protocol matched to your tendon state and goals.
How long until I'm fully recovered?
Tendinopathy is slow to settle — typical recovery is 12+ weeks of consistent loading rehab. Chronic cases can take longer. Faster outcomes come from accurate diagnosis and a programme matched to your specific tendon state.
Do steroid injections help?
Generally no — steroid injections in or around the Achilles carry a real risk of tendon rupture and the evidence for benefit is weak. We typically avoid steroid for Achilles tendinopathy.
What about shockwave therapy?
Shockwave has reasonable evidence for chronic mid-portion tendinopathy that hasn't responded to loading rehab. It's a referral pathway from our assessment if appropriate.