Causes of Achilles Tendonitis

Achilles tendonitis is usually caused by overuse or repeated stress on the tendon rather than a single injury. Common contributing factors include:

• Sudden increase in activity or training intensity
• Tight calf muscles
• Poor foot biomechanics (such as flat feet or high arches)
• Inappropriate or worn footwear
• Repetitive walking, running, or jumping
• Returning to activity too quickly after a break
• Age-related tendon degeneration

Over time, repeated strain can lead to micro-tears within the tendon, causing pain and inflammation.

Stages of Achilles Tendon Injury

Achilles tendon problems typically develop gradually and can be divided into stages:

1. Reactive / Early Stage

• Mild pain or stiffness, especially in the morning or after activity
• Symptoms often ease as the tendon “warms up”
• Tendon may feel slightly thickened

2. Tendon Disrepair

• Pain becomes more frequent and lasts longer
• Reduced performance and strength
• Tendon structure begins to weaken

3. Degenerative Stage

• Ongoing or constant pain
• Significant tendon thickening or nodules
• Higher risk of tendon rupture if left untreated

Early diagnosis and treatment are important to prevent progression and long-term damage.

Diagnosis of Achilles Tendonitis

Achilles tendonitis is primarily diagnosed through a thorough clinical assessment by a qualified healthcare professional, such as a podiatrist.
Diagnosis typically involves:

• Detailed medical history – including activity levels, recent changes in training, footwear, and symptom onset
• Physical examination – assessing pain, tenderness, swelling, tendon thickening, range of motion, and calf muscle flexibility
• Functional assessment – observing walking, running mechanics, and lower limb alignment
• Palpation of the tendon – to identify areas of tenderness, nodules, or thickening

In some cases, imaging may be recommended to confirm the diagnosis or assess the extent of tendon damage:

• Ultrasound – commonly used to evaluate tendon thickness, inflammation, and structural changes
• MRI – may be used if a tendon tear, rupture, or severe degeneration is suspected

Early and accurate diagnosis is essential to guide appropriate treatment, prevent progression of tendon damage, and reduce the risk of chronic pain or rupture.

Treatment Options for Achilles Tendonitis

At our podiatry clinic, treatment is tailored to the severity of the condition, activity level, and underlying causes. Most cases respond well to conservative care.

Shockwave Therapy

Extracorporeal Shockwave Therapy (ESWT) is an effective, non-invasive treatment for chronic Achilles tendonitis.

• Stimulates healing and blood flow
• Reduces pain and inflammation
• Helps repair damaged tendon tissue
• No injections or surgery required

Shockwave therapy is particularly effective for long-standing or stubborn cases that have not responded to rest alone.

Offloading with Custom Insoles

Custom foot orthotics (insoles) are often a key part of treatment.

• Reduce strain on the Achilles tendon
• Improve foot and ankle alignment
• Address biomechanical issues such as over-pronation
• Support healing while allowing you to stay active

Custom insoles are designed specifically for your feet and footwear to provide long-term relief and prevent recurrence.

Surgery (When Required)

Surgery is rarely needed and is usually only considered when:

• Symptoms persist despite prolonged conservative treatment
• There is significant tendon degeneration or tearing
• Pain severely limits daily activities

Surgical procedures may involve removing damaged tendon tissue or repairing the tendon. Your podiatrist will discuss this option thoroughly if conservative treatments are unsuccessful.

When to Seek Treatment

If you experience ongoing heel or Achilles pain, stiffness, or swelling—especially pain that worsens with activity—it’s important to seek professional assessment early. Prompt treatment can prevent the condition from becoming chronic and reduce the risk of tendon rupture.

Book an Appointment

Our podiatrists have extensive experience in diagnosing and treating Achilles tendonitis using evidence-based treatments. We focus on relieving pain, restoring function, and preventing future injury.
Contact our clinic today to arrange an assessment.