How long does Achilles tendinopathy take to get better?

Meaningful change usually takes 3 months of consistent loading, and full return to running or jumping often sits in the 6 to 12 month range depending on how long symptoms were present before starting rehab. The Silbernagel and Crossley JOSPT 2015 framework and the JOSPT 2018 Achilles clinical practice guideline both set expectations around months, not weeks, because tendon collagen remodels slowly. Patience is part of the treatment.

Should I stop running with Achilles tendinopathy?

Usually no. Complete rest tends to detrain the tendon further and symptoms return as soon as running resumes. The Silbernagel pain-monitoring model allows continued running provided pain stays at or below about 5 out of 10 during the run, settles within 24 hours, and does not creep up week over week. If all three conditions hold, running is serving the rehab rather than undermining it.

Do eccentric heel drops still work, or is heavy slow resistance better?

Both work. Alfredson's 1998 protocol of 3 sets of 15 heel drops twice daily for 12 weeks produced results strong enough to reshape tendon rehab globally. Beyer and colleagues (AJSM 2015) compared heavy slow resistance against eccentric training at 12 and 52 weeks and found equivalent outcomes with higher patient satisfaction in the heavy slow resistance group at 12 weeks. I typically pick based on equipment access, schedule, and what the person will actually do three times a week.

Why is my Achilles worst in the morning?

Morning stiffness is one of the most reliable features of tendinopathy. During sleep the tendon sits in a shortened, unloaded position, and the first weight-bearing steps reload tissue that has not been primed. Stiffness that eases within 10 to 15 minutes, and a warm-up period where the tendon feels better during activity, are classic. Stiffness lasting over 30 minutes or worsening through the day signals that loading needs to be dialled back.

What is the difference between insertional and mid-portion Achilles tendinopathy?

Mid-portion pain sits in the soft belly of the tendon 2 to 6 cm above the heel. Insertional pain sits right where the tendon meets the heel bone. The distinction matters because insertional tendons get pinched against the calcaneus when the ankle dorsiflexes deeply, so heel drops off a step are typically avoided early on and flat-ground or slightly-raised calf raises are used instead. Mid-portion cases tolerate and often benefit from the decline heel drop position.

Are cortisone injections a good idea for Achilles tendinopathy?

I steer people away from peritendinous cortisone for the Achilles. Pain relief is short-lived, and there is a real concern about tendon weakening and rupture risk with injection into or around a degenerative tendon. The JOSPT 2018 guideline and most current tendinopathy reviews do not support corticosteroid injection as a primary treatment. Progressive loading remains the cornerstone.

When should I worry about an Achilles rupture versus tendinopathy?

A rupture is almost always a sudden event, often with a pop or a sensation of being struck in the calf, followed by immediate difficulty pushing off or rising onto the toes. Inability to perform even a small single-leg heel raise, or a positive Thompson test (squeezing the calf while lying face-down fails to move the foot), warrants urgent assessment rather than rehab planning. Tendinopathy, by contrast, builds gradually and preserves most strength.

Does ultrasound or MRI change the treatment plan for Achilles pain?

In most cases, no. Imaging often shows tendon thickening, neovascularisation, or focal changes that correlate poorly with symptoms and with prognosis. Two Achilles tendons that look identical on ultrasound can behave completely differently. I order imaging when a partial tear, bursitis, or bone pathology is genuinely on the differential, not as a routine confirmation of tendinopathy.

Achilles Tendinopathy / Tendinitis Treatment in Burlington

Achilles Tendinopathy / Tendinitis

Achilles tendon pain, both insertional and mid-portion

Treating achilles tendinopathy / tendinitis at my Burlington clinic. Convenient for Waterdown and Flamborough residents.

Important: When to seek immediate medical attention

Sudden pop with inability to push off

Assessment for Achilles rupture

Pathophysiology and contributing factors.

Inside Overview

The Science of Achilles Tendinopathy / Tendinitis

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Achilles tendinopathy is a failed healing response characterized by degenerative changes rather than acute inflammation. The condition involves disorganized collagen, increased ground substance, and neovascularization within the tendon. This represents a chronic overuse injury where the cumulative load on the tendon exceeds its adaptive capacity. Two distinct types require different treatment approaches: Mid-portion Achilles tendinopathy (MAT) occurs 2-7 cm from the heel insertion and is primarily a tensile overload condition. Insertional Achilles tendinopathy (IAT) affects the tendon's attachment to the calcaneus and involves both tensile and compressive forces, as the tendon can be compressed against the heel bone during dorsiflexion movements. The pathophysiology involves a breakdown in the normal collagen structure, leading to painful, thickened tissue with reduced mechanical properties. Unlike acute inflammation (tendinitis), this degenerative process (tendinosis) requires specific loading strategies to stimulate proper tissue remodeling rather than anti-inflammatory treatments.

Achilles Tendinopathy / Tendinitis

The Science of Achilles Tendinopathy / Tendinitis

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