Achilles tendinitis is one of the most common overuse injury in active people and athletes.


Studies show that there are no inflammatory cells present in patients experiencing pain in the Achilles tendon. Therefore this condition should properly be named Achilles tendinopathy. The word tendinopathy means that there is a degeneration of the tenocytes (tendon cells) in the Achilles tendon.

Incidence and Prevalence

Achilles tendinopathy is a condition more prevalent in middle aged males.

Types of Achilles tendinopathy:

1. Mid portion 2-6 centimeters from insertion of the tendon to the heel

2. Insertion


Achilles serves as a conjoined tendon of the gastrocnemious and soleous muscles. The average length of Achilles tendon is 12 cm. It changes its orientation by twisting 180° to its insertion onto back side of the heel.



  • Decreased ankle dorsiflexion
  • Abnormal subtalar joint range of motion
  • Decreased strength of ankle plantarflexors
    (muscles pushing the body off)
  • Increased foot pronation


  • Fluoroquinalone (antibiotic medicine)
  • Diabetis
  • Hypertension
  • Arthritis
  • High cholesterol


Clinical history and examination is usually sufficient, however diagnostic ultrasonography is very accurate and preferred in determining the stage and extent of Achilles tendinopathy.


Usually clinical history is very revealing however diagnostic ultrasonography or MRI assists in differentiating location in the Achilles tendon. Radiology also assists in staging tendinopathy which is very important for treatment options.


According to research young athletic individuals respond to treatment faster than middle age adults. For such young patients the treatment may take up to three months, whereas for middle age adults treatment may take up to six months.


Intervention is based on scientific evidence.

Some interventions although having low scientific evidence may work clinically.

Eccentric loading

Taping – insertional type

Manual therapy

Laser and Iontophoresis, ultrasound, steroid injections, plasma injections – all have very low to no scientific evidence.

at NYDNRehab

At NYDNRehab we have extensive experience treating Achilles tendinopathy in runners as well as the non-athletic population. Based on sonographic evaluation and gait (running) analysis we create an individual treatment plan. Treatment options may very depending on type and stage of Achilles tendinoopathy and may involve: combination of manual therapy, eccentric loading exercises, force production exercises, ESWT (Extracorporeal Shock Wave Therapy). Research shows that by far the greatest results were achieved with any type of Achilles tendinopathy by combining ESWT with eccentric loading exercises.


What does successful treatment
of tendinopathy requires:

  • • Patient/athlete education
  • • Inflammation control if inflammation is present
  • • Regenerative treatment (ESWT)
  • • Gradual tendon strenghtening
  • • Loading optimisation (loading and unloading)
  • • Improvement in biomechanics and motor control
  • • Improvment in kinetic chain relationships
  • • Motor variability
  • • Landing or running mechanics
  • • Ergonomics
  • • Training errors
  • • Reversing sensory motor adaptation


In order to avoid treatment for the wrong condition precise diagnosis is best way to deal with this type of injury. High-resolution diagnostic ultrasonography is readily available and is preferred. Another option is an MRI .

Achilles Tendinopathy treatment

Achilles tendinopathy, one of the most common causes of heel pain, is a degenerative condition in which the largest tendon of the body, the Achilles tendon, endures a strains from running, walking, jumping, or strenuous exercise.

While tendinopathy of the Achilles tendon affects both active and inactive individuals, it is most prevalent in athletes, research show 24% of whom will develop this condition. An estimated 50% of runners will Achilles tendinopathy pain at some point in their running career. However, it is also common among people who aren’t athletes or runners: in one study of 58 patients, nearly one-third did not engage in sport related activites. Males experience 89% of all Achilles tendon injuries, the overwhelming majority being men between 30 to 50 years old who are recreational athletes.

What is the Achilles Tendon?

The gastrocnemius and soleus muscles are two muscles at the back of the leg that run the length of the calves from heel to knee. The tendinous portions of these two muscles merge to form the Achilles tendon. A tendon is a band of tissue attached to a bone at one end and a muscle on the other.

Connecting the two calf muscles to the heel bone, the Achilles tendon is surrounded by loose connective tissue (paratendon) that is responsible for much of the blood supply. This blood supply reaches the Achilles tendon through a band of connective tissue similar to a ligament that operates as a set of tunnels for the blood vessels.

Nerves are distributed to the tendon from nerve trunks in the skin, muscles, and around the tendon. These nerve endings are especially sensitive to changes in pressure or tension, sensing and transmitting pain and making the area surrounding the Achilles tendon one of the most vulnerable in the entire body. And, because the Achilles tendon is the largest tendon in the body and the one that allows a person to run, walk, jump, and go up and down stairs, it often suffers from the incredible pressures placed on it by the force of the body’s weight striking against the ground. During running, for example, it is subjected to loads of up to 12 times the weight of the body.

Treatment for tendinopathy of the Achilles varies depending on where in the tendon the pain is located. Mid-portion Achilles tendinopathy afflicts the mid-portion, the largest section of the tendon which lies two to seven centimeters above the calcaneus (heel bone). Insertional Achilles tendinopathy occurs at the juncture where the tendon attaches to the calcaneus. Mid-portion Achilles tendinopathy typically results from too much pressure being placed on the tendon (tensile overload), while insertional Achilles tendinopathy results from compression at the tendon’s insertion (the place where it emerges from the heel bone).

Causes and Symptoms

Both mid-portion and insertional Achilles tendinopathy are caused by excessive or repetitive movement during sports, work, or other activities, which, over time, can create micro-tears in the tendon that become serious injuries.

The primary cause of tendinopathy is excessive pressure placed on the tendon during vigorous physical exertion. When faced with this pressure, the Achilles tendon may respond by either inflammation, degeneration, or both. Injury can occur even if the activities are within the manageable capacity of the tendon. External causes of Achilles insertional tendinopathy may include weak calf muscles, over-pronation of the feet when running, wearing improper footwear, or adding uphill running to an exercise routine. Other risk factors may include misalignment, aging, muscle weakness, muscle imbalance, excessive mileage, and leg length discrepancy.

One of the more common reasons patients develop Achilles tendinopathy is because they begin an activity at a standstill and then try to accelerate more rapidly than their body can handle. This can happen in a variety of ways. For example, someone who doesn’t normally run during their exercise routine may try to compensate by running too much, placing pressure on the feet that the body hasn’t had time to prepare for. Or, during a soccer match, a player might suddenly run towards the goal in an explosive burst of adrenaline, injuring his or her feet in the process. It’s a good general rule to maintain a consistent speed and exercise regimen rather than trying to do too much, too soon.

The most common symptoms of tendinopathy of the Achilles are morning stiffness, tenderness, and recurring pain. The most telling indication that a patient is suffering from an injury of the tendon is the first moments after getting out of bed. The tissues surrounding the tendon tighten at night during sleep but loosen in the morning, sending pain shooting throughout the body. This eases after a few minutes, but often the tendon will remain tender and evince pain when squeezed gently. In some cases the patient may hear an audible clicking when moving the ankle. Pain may recur throughout the day, especially during moments of extreme physical exertion.

Treatment for Achilles Tendinopathy

Approaches for managing Achilles tendinopathy treatment have advanced and become increasingly diverse within the past decade. Researchers and physicians are working together to create practical treatment algorithms which can provide a holistic healing program. Treatments such as extracorporeal shockwave therapy (ESWT) have been proven to best one of the best methods of treatment especially if combined with a physical therapy regimine.

The first priority of treatment for mid-portion and insertional Achilles tendinopathy is reducing the pain of the injured tendon. Because tendinopathy of the Achilles is aggravated by tensile loads, a physician will recommend reducing activities that involve strenuous exercise or walking along uneven surfaces, and not wearing flat shoes or going barefoot. Wearing shoes with a heel, or using a heel raise, may reduce the pressure being placed on the tendon. Calf-stretching is not recommended for all types of Achilles problems. It must be used at a specific stage in the rehabilitation program.

Because tendon pain will hinder the efficacy of muscle function, a doctor may recommend isometric exercises to reduce pain and maintain strength

Even more effective are “eccentric exercises,” which many sports medicine doctors and therapists describe as “the future of Achilles tendinopathy treatment.” Widely regarded as the most powerful non-surgical treatment option, eccentric exercises consist of two different stretches: straight-leg and bent-leg heel drops.

During the reactive stage of Achilles insertional tendinopathy, anti-inflammatory medications such as ibuprofen may reduce pain and swelling. However, these medicines should only be taken under the supervision of a doctor. However, while the tendon is in pain, it isn’t really inflamed, and long-term use of anti-inflammatory medications may harm rather than helping the patient’s recovery.

How Do We Treat Achilles Tendinopathy?

At NYDNRehab we offer comprehensive treatment for achilles tendinopathy. Our highy skilled physical therapists diagnose chronic Achilles tendinopathy by combining a numerous amount of diagnostic methods and approaches. As well at utilizing different types of treatment methods. One of the technologies we use is diagnostic ultrasound, which gives the doctor a real time view and is able to see the extent and possible the severity of the injury. Another modality we have is our complete GAIT Analysis lab, real time a tridimensional view of the forces involved in leg motion, to examine the different vectors of a runner’s body, including individual levels of stability, flexibility, and strength. This allows us to diagnose mechanical faults and prescribe Achilles tendinopathy exercises. Having a clear picture of all aspects of a person’s motion provides insight into the disorders preventing them from living at full capacity.

After locating the causes of tendon and muscle strain, our specialists mobilize the foot and ankle joints and stretch the fibrous tissues around muscles, restoring their ability to support the foot. If the integrity of the tendons or muscle tissues is compromised, we combine stabilization with biological treatment, making use of extra-corporeal shockwave therapy (ESWT) to regenerate damaged tendons and muscles.

Our professionals employ the advanced Computer Assisted Rehabilitation Environment (CAREN) to treat every kind of neuromuscular and musculoskeletal disorder. For those seeking treatment for Achilles tendinopathy, NYDNRehab offers the most comprehensive care and treatment of bones and muscles in NYC


  • Always warm up before exercising
  • Stretch your cuff muscles regularly
  • Strengthen your cuff muscles eccentrically
  • Work on foot stability with your chiro or physio
  • Wear shoes that match your foot type and running style
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