Your guide to Achilles tendinopathy

Written by: Mr Paul Hamilton
Edited by: Cal Murphy

The Achilles tendon will be familiar to anyone who plays or follows sports like football. When injured, it can prevent athletes from participating, and can even hinder mobility in everyday life. How does the Achilles tendon get injured, how serious is it, and can it be treated? Top Doctors’ resident expert Paul Hamilton gives us the facts:

Did you know…?


  1. The Achilles tendon is the thickest and strongest in the body – it has to be to anchor the calf and other muscles in the leg to the heel.
  2. The Achilles tendon enables us to walk and run, providing flexibility and movement to the ankle. A healthy Achilles is essential for normal mobility.
  3. The Achilles is the most commonly injured tendon. Tendinitis is the most common problem, but heals quickly if diagnosed and treated. Ruptures or tears are more severe, rendering the sufferer immobile.
  4. The Achilles tendon was named for the mythological Greek hero Achilles, who was made invulnerable when his mother, the goddess Thetis, dipped him in the River Styx as a baby. As she held him by the heel, this was the only part of him that was unprotected, and he later died when shot in the heel by an arrow by the walls of Troy.
  5. Tendinopathy, tendinitis and tendinosis do not all mean the same thing! Read more below.

Why do I have pain in my Achilles tendon?


While there probably isn’t an arrow stuck in your heel, you may have found your heel to be a weak spot. Achilles tendinopathy is pain at the back of the heel either where the Achilles inserts (insertional) or just above this area (non-insertional). The pain is often worse first thing in the morning and may be associated with a lump and swelling.

Heel pain can also be caused by plantar fasciitis, rather than Achilles tendinopathy.


Tendon terms


While ‘tendinopathy’ refers to painful conditions of a tendon in general, this can be subdivided into tendinitis and tendinosis.

‘Tendinitis’ refers to inflammation of a tendon, whereas ‘tendinosis’ describes damage to a tendon at a cellular level, which may not be accompanied by inflammation, and is a chronic condition.


How do you get rid of Achilles tendonitis?


It is always best to tailor treatment to each specific patient. Physiotherapy is a common option, and may be used in conjunction with other treatments, such as insoles, gait analysis, podiatric assessment, extra-corporeal shockwave therapy and sometimes even surgical procedures.


Surgical treatment of Achilles tendinopathy

If the above treatments fail then surgical treatment directly to the Achilles may be an option that can be discussed during the consultation. This may involve stripping the Achilles, removing damaged Achilles tendon or transferring another tendon to help in the healing process and improve function. Recovery may take several months and will require a period of immobilisation in a cast or a boot.


If you experience prolonged heel pain or ankle pain, it is a good idea to see your doctor or a specialist.

By Mr Paul Hamilton
Orthopaedic surgery

Mr Paul Hamilton is a top orthopaedic consultant based in Surrey and South London. He specialises in adult foot and ankle surgery and trauma surgery, including forefoot reconstruction, arthroscopy and arthroplasty, and is an expert in treating sport injuries, Morton's neuroma, arthritis and bunions.

After qualifying from St Bartholomew's and the Royal London Medical School, he completed three medical fellowships in the UK and a travelling fellowship to Boston, USA, giving him extensive specialist training. In addition to his private and NHS practices, Mr Hamilton is actively involved in research, and has published and presented his work in orthopaedics around the world.

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