Last updated: October 2026
Achilles tendonitis, now usually called Achilles tendinopathy, is pain and stiffness in the tendon at the back of your heel, often worst first thing in the morning. It is usually an overload problem. Most people improve over a few months with load changes and calf-strengthening exercises, but it can take a year or longer.
Below: symptoms, causes (including a medicine link many people miss), how to tell it from plantar fasciitis, a step-by-step exercise plan, the evidence on heel lifts, shockwave and injections, recovery time and when to get help.
Need help now? If you felt a sudden snap or pop at the back of your ankle, or it felt as if someone kicked you in the back of the heel or calf, and now you can’t push off, walk normally or stand on tiptoe, you may have ruptured your Achilles tendon. Get it checked the same day at an urgent treatment centre or A&E, or call 111. Don’t wait to see if it settles. See all the red flags.
Achilles tendonitis symptoms
Your Achilles tendon is the thick cord that joins your calf muscles to your heel bone. It is what lifts your heel when you walk, run, jump or climb stairs. NHS inform lists these symptoms:
- pain at the back of the heel or lower calf that is worse during or after activity
- stiffness that is worse in the morning or after sitting for a while
- tenderness when you squeeze or press the tendon
- swelling and mild heat
- loss of movement and strength around the ankle and foot
The classic pattern: pain that warms up, then comes back. An NHS physiotherapy leaflet from Northern Devon describes pain at the start of exercise that fades once you’re going, then returns when you stop. Later it can hurt during exercise and become constant. Hills and stairs often hurt more, and the tendon may feel lumpy. It affects people who aren’t sporty as well as athletes.
Tendonitis or tendinopathy: what’s the difference?
“Tendonitis” means an inflamed tendon, and it is still the word most people search for. Clinicians now prefer “tendinopathy”, because a long-lasting sore Achilles usually shows wear in the tendon tissue rather than ongoing inflammation. You may also see “tendinosis”. All three describe the same problem with the same treatment: rebuild the tendon’s tolerance to load.
Mid-portion vs insertional Achilles tendinopathy
Where it hurts matters, because the two types respond differently to some exercises. The Dutch multidisciplinary guideline splits them at 2cm above the heel bone.
| Feature | Mid-portion | Insertional |
|---|---|---|
| Where it hurts | In the cord itself, more than 2cm above the heel (often 2 to 6cm up) | Where the tendon attaches to the heel bone, within 2cm |
| How common | The most studied: 86% of patients in treatment trials | Too few trials to compare treatments reliably |
| Often found with | A thickened, tender section of tendon | A bony bump on the back of the heel (Haglund’s) or an inflamed bursa |
| Heel drops off a step | Good results: 89% of 101 tendons back to activity in one Swedish study | Only 32% did well in the same study. Do heel raises on a flat floor instead |
What causes Achilles tendonitis? Risk factors
Trouble usually starts when load jumps beyond what the tendon is used to, or inactivity leaves it weaker. NHS inform and NHS physiotherapy leaflets list:
- A change in load: doing more, faster or further, a new sport, adding hills or stairs, or starting again too quickly after a break. Our guide to how many steps a day you need explains how to build up.
- Long spells standing still, or a sedentary routine that weakens muscles and tendons.
- Unsuitable footwear, a sudden change of shoes, or weak calf muscles.
- Age: the tendon becomes less flexible as you get older. A Dutch GP study found about 2.35 new cases per 1,000 adults aged 21 to 60 a year, and only about a third were linked to sport.
- Smoking, being overweight, diabetes and inflammatory arthritis.
- A previous Achilles problem: the strongest risk factor in a study of 1,929 recreational runners.
Medicines: fluoroquinolone antibiotics and steroids
Fluoroquinolone antibiotics, such as ciprofloxacin, levofloxacin, moxifloxacin and ofloxacin, can damage tendons, especially the Achilles. The MHRA, the UK medicines regulator, warns this can start within 48 hours or appear months after the course ends. The risk is higher if you’re over 60, have kidney problems, have had an organ transplant, or take steroid medicines at the same time. If a tendon hurts or swells while you’re taking one, the MHRA advice is to stop the antibiotic, rest the area and contact your doctor straight away. Steroid injections near the tendon are also a concern (see injections).
Achilles tendonitis vs plantar fasciitis and heel bursitis
The NHS advises against diagnosing heel pain yourself, but where it hurts is the best clue.
| What you notice | Likely cause | What to do |
|---|---|---|
| Pain at the back of the heel, ankle and lower calf; stiff in the morning; worse on tiptoe, hills or stairs | Achilles tendinopathy | Self-care and the exercises below |
| Sharp pain under the heel and arch, worst with your first steps in the morning, easing as you move | Plantar fasciitis | See our plantar fasciitis guide |
| Redness, swelling and a dull ache around the back of the heel | Bursitis (a fluid-filled cushion near the tendon), sometimes alongside insertional tendinopathy | Rest, ice and padding; see a GP if it doesn’t settle |
| Sudden pain, a snap or pop, feeling kicked in the calf, can’t push off or stand on tiptoe | Achilles rupture (or a broken heel bone) | Same day: urgent treatment centre, A&E or 111 |
Pain in other joints too? See our guides to knee pain, hip pain and joint pain.
What to do today
NHS inform is clear that Achilles tendinopathy does not get better with rest. The aim is relative rest: cut back what flares it, keep everything else going.
- Change the load, don’t stop. Keep up as much normal activity as you can, taking breaks, doing less or swapping activities. Cycling or swimming can replace running for a while.
- Ice or heat: use whichever feels better, wrapped in a towel, for up to 20 minutes, with a few hours between goes. Skip it if you have poor circulation or reduced feeling. Read our hot water bottle safety guide first.
- Painkillers: the NHS says paracetamol, ibuprofen or ibuprofen gel can ease tendon pain; ask a pharmacist which suits you. The Dutch guideline advises caution with anti-inflammatories, so treat them as short-term help, not the fix.
- Shoes: supportive, with a low heel; avoid long spells barefoot. A small heel lift can take some strain off.
- Before your first steps: gently point and flex your foot about 10 times before getting out of bed or standing up after sitting.
- Work: NHS inform says you don’t need to be symptom free to go back, and returning as soon as you can helps recovery.
Achilles tendonitis exercises
Calf-strengthening is the backbone of treatment. Move on only when a step feels easy.
The pain rule (from NHS inform): rate pain from 0 to 10. Keep it at 5 or below while exercising. Your pain should be no worse the next morning. If it is, do fewer, go slower or rest longer between sets.
- Seated heel raises. Sit with your feet flat, slowly lift your heels as far as is comfortable, then lower slowly.
- Standing heel raises on both feet. Hold a wall or chair, rise onto your toes, hold for a few seconds and lower slowly. Start with 2 to 3 at a time through the day, then build to sets of 8 with a minute’s rest, up to 2 sets of 15.
- Single-leg heel raises on the sore side, as pain allows.
- Heel drops off a step (mid-portion only). Stand with the balls of your feet on a step. Rise up on both feet, then lower slowly on the sore leg so your heel drops below the step. This is the “eccentric” exercise made famous by a Swedish team led by Alfredson. If your pain is at the heel bone (insertional), keep all heel raises on a flat floor.
- Add weight. Hold a weight, wear a loaded rucksack or use a gym calf-raise machine, keeping the raises slow. This is heavy slow resistance.
- Calf stretch. Lean on a chair with one leg behind you until you feel a gentle stretch. Work up to holding for 20 to 30 seconds.
A physio can tailor the plan and add hopping before you return to sport.
What the research says
- Eccentric heel drops: in Alfredson’s small 1998 study, all 15 recreational athletes were back running after 12 weeks.
- Heavy slow resistance: a Danish trial of 58 people found it worked as well as eccentric training at 12 weeks and one year, and people stuck with it better (92% of sessions against 78%).
- No single best exercise: a 2021 analysis of 29 trials found any active treatment beat wait-and-see at 3 months, with no clear winner, though certainty was low. A 2026 review of 21 trials found eccentric work no better than other exercise programmes.
The honest summary: which exercise you choose matters less than doing it steadily for at least 12 weeks. For rest days, sleep and food, see muscle recovery.
Heel lifts, insoles and shoes
A small heel lift in both shoes reduces the stretch on the tendon, and NHS physiotherapy leaflets suggest one. In an Australian trial of 100 adults with mid-portion tendinopathy, heel lifts did slightly better than eccentric exercise at 12 weeks, though the gap was just short of clinically meaningful. Both are reasonable starting points.
If it hasn’t settled within a few months, a podiatrist can check your footwear. The Dutch guideline lists night splints, insoles and collagen supplements as optional extras when exercise isn’t enough, with limited evidence. Our collagen supplements guide looks at the research honestly.
Shockwave, injections and surgery
- Shockwave therapy (ESWT): NICE found no major safety concerns but says evidence that it works is “inconsistent and limited in quality and quantity”. It should only be used with special arrangements for consent and audit or research. Availability on the NHS varies.
- Steroid injections: the Dutch guideline urges caution. A Cochrane review of 18 injection trials found too little evidence to support routine use of any injection, and the one major side effect it recorded was an Achilles rupture after a steroid injection. A 2022 Danish trial of ultrasound-guided steroid injections plus exercise did report better results at 6 months without serious side effects. So it is a specialist decision, not a quick fix: ask about the risks if one is offered.
- PRP (platelet-rich plasma) injections: a specialist may discuss them, but the same Cochrane review found too little good evidence to support them routinely.
- Surgery: the Dutch guideline says to consider it only after more than six months of proper treatment hasn’t helped.
How long does Achilles tendonitis last?
Usually months, not weeks. NHS inform says it takes several months or more in most cases. A 2026 NHS leaflet from Sherwood Forest Hospitals says healing normally takes 6 to 12 weeks, but discomfort and swelling for longer is normal.
- Most people do recover. In a Swedish study, 80% of people treated with exercise alone had fully recovered after 5 years. In a Finnish study, 84% were back to their full activity level after 8 years.
- A minority keep symptoms. A third of runners who developed it still had symptoms a year later. In a Dutch study, 19% of people still had symptoms 10 years on.
- The other side can follow. In the Finnish study, 41% later developed symptoms in the other Achilles, so keep up the calf exercises once you’re better.
Talk to a GP or physio if it hasn’t improved after 12 weeks of following the advice, or if it is getting worse.
Can you run with Achilles tendonitis? Returning to running
Often, yes, if you keep pain in check. In a Swedish trial of 38 people, those who kept running and jumping during rehab, guided by their pain levels, did as well over 12 months as those who stopped for six weeks. Use the exercise pain rule: no higher than 5 out of 10, and no worse the next morning.
- Be patient. The Dutch guideline says returning to sport within days is linked with a higher chance of it coming back. A return to full, symptom-free running usually takes at least a few months of active treatment.
- Build back gradually: shorter, flatter, slower runs first. Walk-run intervals such as Japanese walking work well.
- Keep doing calf exercises after you recover.
A Dutch study found about 1 in 20 recreational runners develop it, and about 1 in 14 marathon entrants. For more on training and recovery, see CBD for athletes.
Red flags: when to get urgent help
Get seen the same day (urgent treatment centre, A&E or call 111) if:
- you felt a sudden snap or pop, or as if you’d been hit or kicked in the back of the calf or heel
- you can’t stand on tiptoe, push off when walking, or walk up stairs
- you have severe pain after an injury, or swelling and bruising in your calf and ankle
- your foot or ankle has changed shape or is at an odd angle
- the pain makes you feel faint, dizzy or sick
Call 111 or ask for an urgent GP appointment if your heel or ankle is red, hot and swollen and you have a very high temperature or feel hot and shivery. Contact your GP practice if your calf is hot, swollen and tender.
When to see a GP or physio
The NHS says to see a GP about heel pain if it is severe, stops you doing normal activities, is getting worse or keeps coming back, hasn’t improved after 2 weeks of home treatment, or comes with tingling or numbness in your foot. Also see a GP if you have diabetes and heel pain.
Physio without a GP: in many areas you can refer yourself to NHS community musculoskeletal (MSK) services. A physio can confirm whether it is mid-portion or insertional and tailor your loading plan.
Similar overload problems affect other tendons and tissues: see tennis elbow and plantar fasciitis, or body aches if you ache all over.
Where our products fit (honestly)
No supplement or balm is a treatment for Achilles tendonitis. Loading exercises, sensible changes to your training and proper advice are what help.
Our CBD Balm, Muscle and Joint Support is a massage balm made with broad spectrum CBD, peppermint, eucalyptus and juniper. It feels cooling and non-greasy, and some people like to massage it into the calf after their exercises or a run. CBD isn’t a treatment for Achilles tendonitis or any tendon problem. Don’t use it on broken or irritated skin. See our CBD balm guide for how to use a balm and CBD for pain for what the trials show.
Our Magnesium Glycinate Sleep Complex is an evening drink with magnesium bisglycinate and citrate, glycine and L-theanine. Magnesium contributes to normal muscle function. It won’t fix a sore tendon, but if calf cramps bother you too, read leg cramps at night, magnesium for cramps and magnesium for muscle pain.
If you also take CBD by mouth, keep the FSA’s advice in mind. The FSA’s 10mg a day figure is precautionary advice rather than a legal limit, set while longer-term safety research continues. At Evopure we think it is a very cautious figure, and many adults use more. If you go above it, increase slowly, and check with your GP or pharmacist first if you take any medication.
Our products are for adults (18+) only. We don’t recommend our products during pregnancy or breastfeeding. If you take prescribed medicines, check with your pharmacist before adding a supplement.
FAQs
What is the fastest way to heal Achilles tendonitis?
There’s no quick fix. Cut back the activity that flares it without stopping completely, wear supportive shoes, consider a small heel lift and do progressive calf-strengthening exercises for at least 12 weeks.
How long does Achilles tendonitis take to heal?
Usually several months. Most people recover fully, but about a third of runners still have symptoms a year later. See a GP or physio if it hasn’t improved after 12 weeks.
Should I rest Achilles tendonitis completely?
No. Complete rest doesn’t help it heal. Reduce or change the activities that make it worse and keep up gentle movement and loading exercises, keeping pain at 5 out of 10 or below.
Is walking good for Achilles tendonitis?
Usually, yes. Keep walking at a level that doesn’t push pain above 5 out of 10 or make it worse the next morning. Avoid long spells barefoot, steep hills and lots of stairs while it settles.
What is the difference between Achilles tendonitis and plantar fasciitis?
Achilles tendonitis hurts at the back of the heel and lower calf. Plantar fasciitis hurts underneath the heel and arch, mostly with your first steps in the morning.
Can antibiotics cause Achilles tendonitis?
Yes. Fluoroquinolone antibiotics such as ciprofloxacin can damage tendons, especially the Achilles, sometimes within 48 hours or months later. If a tendon hurts or swells while taking one, stop and contact your doctor straight away.
How do I know if I’ve torn my Achilles?
A rupture usually happens suddenly, often with a snap or a feeling of being kicked in the calf, and you can’t push off or stand on tiptoe. Get seen the same day at an urgent treatment centre or A&E, or call 111.
Sources
- NHS inform. Achilles tendinopathy, Exercises for calf and ankle problems and Ankle problems.
- NHS. Tendonitis, Heel pain and Get NHS help for back and joint problems.
- Northern Devon Healthcare NHS Trust. Achilles tendinopathy (patient leaflet, PDF).
- Sherwood Forest Hospitals NHS Foundation Trust. Achilles tendinopathy (patient leaflet, revised July 2026, PDF).
- Cambridge University Hospitals. Achilles tendon rupture.
- MHRA Drug Safety Update. Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate (January 2024) and new restrictions and precautions for use (March 2019).
- NICE. Extracorporeal shockwave therapy for Achilles tendinopathy (HTG426, formerly IPG571). 2016.
- de Vos RJ, et al. Dutch multidisciplinary guideline on Achilles tendinopathy. Br J Sports Med, 2021. PMID 34187784.
- Alfredson H, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med, 1998. PMID 9617396.
- Fahlström M, et al. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc, 2003. PMID 12942235.
- Beyer R, et al. Heavy slow resistance versus eccentric training as treatment for Achilles tendinopathy: a randomized controlled trial. Am J Sports Med, 2015. PMID 26018970.
- van der Vlist AC, et al. Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. Br J Sports Med, 2021. PMID 32522732.
- Yuan F, et al. The efficacy of eccentric exercise in the treatment of Achilles tendinopathy: a systematic review and meta-analysis. BMC Musculoskelet Disord, 2026. PMID 42021217.
- Rabusin CL, et al. Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (HEALTHY): a randomised trial. Br J Sports Med, 2021. PMID 32988930.
- Kearney RS, et al. Injection therapies for Achilles tendinopathy. Cochrane, 2015. PMID 26009861.
- Johannsen F, et al. Effect of ultrasonography-guided corticosteroid injection vs placebo added to exercise therapy for Achilles tendinopathy: a randomized clinical trial. JAMA Netw Open, 2022. PMID 35816306.
- Silbernagel KG, et al. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy. Am J Sports Med, 2007. PMID 17307888.
- Silbernagel KG, et al. The majority of patients with Achilles tendinopathy recover fully when treated with exercise alone: a 5-year follow-up. Am J Sports Med, 2011. PMID 21084657.
- Paavola M, et al. Long-term prognosis of patients with Achilles tendinopathy: an observational 8-year follow-up study. Am J Sports Med, 2000. PMID 11032217.
- Lagas IF, et al. One fifth of patients with Achilles tendinopathy have symptoms after 10 years. J Sports Sci, 2022. PMID 36617848.
- Lagas IF, et al. Incidence of Achilles tendinopathy and associated risk factors in recreational runners. J Sci Med Sport, 2020. PMID 31892510; and How many runners with new-onset Achilles tendinopathy develop persisting symptoms? Scand J Med Sci Sports, 2020. PMID 32615645.
- de Jonge S, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med, 2011. PMID 21926076.
This guide is general information, not medical advice. If you’re worried about heel or ankle pain, speak to a GP, pharmacist or physiotherapist. Evopure makes the CBD Balm, Muscle and Joint Support and the Magnesium Glycinate Sleep Complex.
