Achilles tendinopathy

Achilles tendinopathy is overload of the heel cord where the calf muscles attach to the heel bone. Morning stiffness and pain with the first steps or during speed work are classic.

What it feels like

Pain sits in the mid-portion of the Achilles or lower near the insertion on the heel.

The first steps out of bed or after sitting can feel especially stiff, then warm up, then flare again with hills or speed.

A sudden pop with immediate weakness is a different emergency pattern that suggests rupture.

What is going on

Tendon collagen becomes irritable and less tolerant of rapid load spikes, training errors, or abrupt hill work.

Insertional and mid-portion patterns behave a little differently and influence exercise selection.

Systemic factors and calf weakness often contribute alongside training load.

How we evaluate

Tendon palpation, heel-rise endurance, and training history usually establish the diagnosis.

We screen for rupture signs and insertional bony contributors.

Ultrasound or MRI is used when the diagnosis is unclear or a procedure is being planned.

What we may offer

Progressive tendon loading (often eccentric or heavy-slow patterns) through physical therapy is first-line.

Training redesign matters as much as any procedure. PRP may be discussed for selected persistent cases.

Complete rupture or failed chronic insertional disease can require surgical pathways.

Should I stretch aggressively?

Aggressive end-range stretching can irritate some Achilles tendons. We usually prioritize progressive loading over aggressive stretching alone.

Can I keep running?

Sometimes with reduced volume and intensity while capacity rebuilds. That call is individualized.

Is a cortisone shot into the Achilles a good idea?

Injecting corticosteroid into the Achilles tendon itself is generally avoided because of rupture concerns. Alternatives are discussed carefully.

How is tendinopathy different from a tear?

Tendinopathy is overload and degenerative change with an intact tendon. A full rupture is an acute loss of continuity with sudden weakness.