Achilles Tendinopathy


  • Presents as pain, swelling, and stiffness in the lower poster leg behind the heel; caused by repetitive tiny injuries, lack of flexibility, over-pronation, recent changes in footwear, and changes in exercise training schedules.
  • Common also in patients with ankylosing spondylitis and psoriatic arthritis.
  • Can be seen on patients taking medicine from group of fluoroquinolones (e.g. ciprofloxacin, ofloxacin) for long period.
  • Genetic predisposition is a risk factor.

Diagnostic tips

  1. Pain and swelling on the heel area.
  2. Exclude tear by palpation and Thompson test.
  3. Most prominent pain in the area about 2-4 cm above where the tendon attaches to the heel.
  4. Experience the most significant pain after periods of inactivity.
  5. Limited range of motion in the ankle.
  6. Thickening or enlargement of the Achilles tendon.

Tests and Imaging

  1. X-rays could be normal but is essential to evaluate other possible conditions.
  2. Ultrasound or MRI performed for evaluation of tears within the tendon.

Immediate Treatment

  1. Crutches and immobilization of ankle for tears.
  2. May take over 6 months to heal.
  3. R.I.C.E.R.
  4. Analgesia

Possible Referral

  1. Podiatry for immobilisation with cam walker, orthoses, footwear advice, stretching/strengthening program.
  2. Orthopaedic surgeon for surgical repair..