Private achilles tendinopathy clinic in London, same-day physiotherapy.

Two patterns

• Mid-portion tendinopathy — pain and thickening 2 to 6cm above the heel bone. The commoner and more treatable form.
• Insertional tendinopathy — pain right at the heel bone attachment, often with a bony prominence. Needs a modified programme, avoiding stretch into dorsiflexion.
• Both are typically worst on the first steps in the morning and after sitting, ease with gentle activity, then ache afterwards.

The loading programme

1. Start with isometric holds if very painful — rise onto toes and hold for 30 to 45 seconds, five times, several times a day. These reduce pain and allow you to begin.
2. Progress to heel drops. Rise onto both toes, shift weight to the affected leg, and lower slowly over three to four seconds. Three sets of 15, once or twice daily.
3. For mid-portion pain, drop below step level; for insertional pain, stay on flat ground and do not stretch beyond neutral.
4. Add load progressively — a rucksack with weight, then a calf raise machine. The tendon needs meaningful load to remodel.
5. Expect a delayed response. Judge by how the tendon feels the next morning, not during exercise. Worse the next day means reduce; the same or better means progress.

Alongside

• A heel raise in both shoes offloads the tendon during the painful phase.
• Reduce, do not stop. Cut running volume and hills, switch some sessions to cycling or swimming, but keep loading the tendon.
• Shockwave therapy has reasonable evidence where a loading programme has not worked after three months.
• Avoid steroid injection into the tendon itself.
• Check for contributing factors — a sudden increase in training, new footwear, calf tightness, and less obviously diabetes, high cholesterol and inflammatory arthritis.

If it is a rupture

Treatment is either a functional brace and rehabilitation programme, or surgical repair. Outcomes are broadly similar for many people, with surgery carrying a slightly lower re-rupture rate and higher complication risk. Either way, recovery takes several months and rehabilitation is the determining factor. What matters most is starting promptly — delayed diagnosis makes both options harder.