Achilles Tendinopathy: Heel Pain Treatment

Dr. Angela Walk
Aug 1, 2024
4 min read

Updated: Jul 20

The Achilles tendon is a thick tendon located in the back of the leg. It connects the gastrocnemius and soleus muscles in the calf to an insertion point at the calcaneus (heel bone).

It is the strongest tendon in the body and allows people to push off while walking, running and jumping.

Achilles injuries can occur in several places, but the most common area is at the muscle-tendon junction, the area where the calf muscles join with the tendon.

Causes Of Achilles Tendinopathy

Also known as Achilles tendinitis, this is a chronic condition that causes weakness and breakdown of the tendon due to a series of small tears.

Developing Achilles Tendon pain is a common finding when our calf muscle group (gastrocnemius, soleus, achilles) is chronically shortened from heel elevation in footwear.

Achilles tendon pain can also develop from a repetitive strain or repeated stress that is too much for your calf muscles to manage.

Most often I see Achilles Tendinopathy in those who have a sudden increase of their training intensity or volume without the proper conditioning phase.

Achilles Tendon Recovery

Most cases of Achilles tendinopathy can be treated with conservative treatment. The most effective treatment of the tendon includes loading the tendon progressively.

Achilles injuries can be difficult to treat, especially without the right guidance. Many foot practitioners and physical therapists underload the tendon, which hinders recovery.

Tendons Need Progressive Loading

Tendons speak only in the language of load. Tendons need some controlled loading to begin to strengthen and remodel.

if you don’t load the tendon enough, its capacity will be diminished. Bodyweight exercises aren’t enough!

Progressive loading or progressive resistance is the method of gradually increasing the difficulty or intensity of rehab efforts over time.

The goal is to challenge the tendons and improve strength and muscle development.

The Solution

Transition To Functional Footwear:

The first step is to transition out of footwear with an elevated heel.

Most conventional footwear has elevation of the heel. The industry standard is 8-12mm.

Long-term use of this type of footwear causes a chronic tightening of the calf muscle complex, and leads to many foot conditions, including AT.

A slow, gradual transition to zero drop footwear is ideal. This will place all the lower leg muscles back into their natural length-to-tension relationship.

Find my Approved Shoe List here with footwear options that are widest at the toe and zero drop.

2. Remove Fascial Adhesion:

With a repetitive strain, soft tissue adhesions develop, and must be removed to improve tensile strength and mobility.

Use the fascial release tool on the gastrocnemius, soleus, and achilles tendon. Perform every 2 days.

3. Implement Progressive Loading:

Progressive loading is one of the most effective rehabilitation principles we have.

It simply means you start with a level of exercise your tissues can tolerate, and then gradually increase the challenge as they become stronger.

This teaches your foot and achilles tendon how to handle load again. That's how real healing occurs.

One of my favorite ways to do this is with calf raises performed while your toes are slightly elevated. I designed a tool called the FasciaFlex Trainer specifically for this exercise. If you don't have the trainer, you can use a rolled up towel underneath your toes.

Now let me give you a quick science lesson because this part is incredibly important.

When your big toe bends upward into extension during walking, it tightens the plantar fascia, raises your arch, and transforms your foot into a stable lever so you can push off efficiently.

This process is called the windlass mechanism, and it's one of the most important functions of the foot and lower leg.

Unfortunately, in many people with achilles tendon issues, that mechanism becomes weak and inefficient.

There are 3 exercises below. Start with exercise number one and perform 2-3 set of 12-15 reps every other day. In 2 weeks, incorporate exercise number 2. In another 2 weeks, add exercise number 3.

Exercise 1. Calf Raises With A Ball Between Your Heels

We always begin with double-leg calf raises. Place your toes on the rolled towel or FasciaFlex Trainer.

Slowly rise onto the balls of both feet, pause briefly at the top, then lower under control. I recommend one to three sets of fifteen repetitions every other day.

Exercise 2. Eccentric Loading Calf Raises

After about two to three weeks, once that becomes comfortable, we move to eccentric calf raises. This is the classic "up on two, down on one" progression. Rise onto your toes using both feet. Then lift one foot off the ground and slowly lower yourself using only the affected leg. Again, perform one to three sets of fifteen repetitions every other day.

Exercise 3. Single Leg Calf Raises

Finally, when your strength and symptoms allow, progress to single-leg calf raises.

This is where your foot really begins to develop strength, resilience, and the capacity to tolerate everyday activities like walking, hiking, pickleball, and running without constantly becoming irritated.

The key is slow, controlled movement and gradually increasing the challenge over time. That's exactly how tendons, fascia, and muscles adapt.

That’s it. That’s how you use a progressive approach to strengthening your feet and lower leg.

This simple progression became one of the biggest reasons my patients started recovering faster and staying pain-free.

Exercise 4: Improve Ankle Dorsiflexion

Limited ankle dorsiflexion, the ability to bring your knee forward over your foot, can place excessive stress on the Achilles tendon during walking and running.

When the ankle doesn't have enough dorsiflexion, your heel often lifts off the ground earlier than it should during gait.

This early heel rise forces the Achilles tendon to absorb more load over and over again, increasing irritation and slowing recovery.

One of the best ways to improve ankle dorsiflexion is with kneeling ankle rocks.

Start in a half-kneeling position with your front foot flat on the floor. Keeping your heel down, slowly drive your knee forward over your toes until you feel a gentle stretch in the ankle. Return to the starting position and repeat in a slow, controlled manner.

As your ankle mobility improves, your walking mechanics become more efficient, reducing unnecessary strain on the Achilles tendon with every step.