Achilles tendonitis

In short: the Achilles tendon does not inflame as much as it “wears out,” so the treatment seeks to help it recover, not just calm it down. With exercise, shock waves, and insoles, and often without giving up sport entirely. We assess it with ultrasound.

Achilles tendinopathy is the pain and stiffness of the tendon that connects the calf to the heel. It is typical in active people and is felt especially when starting up (in the morning or after sitting).

More than an inflammation, it is usually a wear and tear of the tendon due to overload. Therefore, treatment is not just about “calming the pain,” but helping the tendon recover and correcting what was making it work too hard.

Achilles Tendinitis in Runners

It is one of the most repeated injuries among those who run, and almost always there is a pattern behind it: the tendon tolerates sudden changes poorly. Increasing the volume or pace all at once, adding hill repeats, switching to footwear with less drop, or returning to hard training after a stop are the classic triggers.

Therefore, with runners, the visit goes beyond the foot: we review the training history, footwear, and technique, and analyze biomechanics with the gait analysis. Often the solution is not to stop running, but to reorder loads and correct what makes the tendon work harder — the usual approach of sports podiatry.

Why total rest is usually not the solution

Instinct says “stop until it stops hurting.” With tendons, this strategy usually backfires: the tendon is living tissue that adapts to the load it receives. If you leave it in absolute rest, it deconditions; and when you return to activity, the pain reappears — sometimes sooner than before.

The current approach is to manage the load, not eliminate it: reduce what irritates it, maintain what the tendon tolerates, and progress with prescribed strength exercises. In cases that get stuck despite doing it right, regenerative treatments help stimulate tissue recovery. Patience is part of the treatment: tendons improve, but at their own pace.

Not all pain behind the heel is the tendon

In the heel area, various structures coexist, and getting the diagnosis right changes the treatment. Pain can come from the body of the tendon, from its insertion into the bone, from the bursa in front of it, or from a bony prominence that rubs against footwear. And if the pain is below the heel instead of behind it, suspicion points to another condition: we explain it on the heel pain page.

Here, ultrasound is a great ally: we do it during the first visit, so we see the state of the tendon at that moment and can name the problem before deciding anything.