Achilles Tendinopathy
If the back of your ankle has been painful, stiff first thing in the morning, or sore after a run or a long walk, there is a good chance you are dealing with Achilles tendinopathy.
It is a common condition, and one our team has a lot of experience treating successfully.
What is actually happening: The Achilles is the thick tendon connecting your calf muscles to your heel bone. When it is placed under more load than it can comfortably handle, the tendon can become irritated and start to break down slightly at a microscopic level. That process is what causes the pain, stiffness, and sometimes swelling you feel around the back of the ankle.
There are two main areas where Achilles tendinopathy tends to develop. Mid-portion tendinopathy affects the middle section of the tendon, a few centimetres above the heel, and is the more common of the two. Insertional tendinopathy affects the point where the tendon meets the heel bone itself. The location matters because the two presentations can behave differently and respond to slightly different approaches, so working out which you are dealing with is part of what a good assessment covers.
What tends to cause it
The most common driver is a change in load: doing more than your tendon is used to, whether that is stepping up training, adding more walking, returning to activity after time off, or simply spending longer on your feet than usual. Distance runners know this condition well, but you do not have to be particularly active to develop it.
Biomechanics often play a part too. The way your foot, ankle, and calf work together influences how load is distributed through the tendon, which is why two people doing the same activity can have very different outcomes. Things like calf tightness, foot posture, and footwear can all contribute.
How we approach it at Brixton Therapy Centre
The right starting point is an osteopathic assessment. Your osteopath will look at the tendon itself alongside your calf, ankle, and foot mechanics, as well as your spine and pelvic alignment, to understand what is driving the problem and what the most effective approach will be.
For presentations that are more recent or straightforward, hands-on osteopathic work typically forms the core of the plan. This addresses the surrounding structures, calf tension, and movement patterns that are loading the tendon.
If your Achilles tendinopathy has been going on for a while and you have already had a scan confirming tendon change without any sign of a tear, shockwave therapy is likely to be the primary recommendation. For persistent tendinopathy, shockwave is one of the most well-supported treatments available, and it is often the most direct route to meaningful improvement. All of our osteopaths who carry out shockwave are fully registered with the General Osteopathic Council and have completed additional specialist training in its use. If your osteopath recommends it, it will be because they have assessed it as the right choice for your specific situation.
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You do not need a confirmed diagnosis to come in
Many people arrive unsure whether they have Achilles tendinopathy, a heel issue, or something else entirely, and that is completely fine. If the back of your ankle has been bothering you and is not settling on its own, that is enough reason to book an appointment. Our osteopaths will assess what is going on from scratch and go from there.
Questions People Ask Us
Will I need a scan before coming in?
Not necessarily. Many presentations of Achilles tendinopathy can be assessed and treated without imaging. If you have already had a scan, your osteopath will take that into account. If they feel one would be helpful, they will explain why and point you in the right direction.
I have had Achilles pain for months. Is it still worth coming in?
Yes. Longer-standing tendinopathy can take more time to fully resolve than a recent flare-up, but it does respond well to the right treatment. In fact, persistent tendinopathy is one of the presentations where shockwave therapy tends to be particularly effective. A thorough assessment will establish what is still driving it, and the plan is built from there.
Should I rest completely while I am being treated?
Rest alone rarely resolves Achilles tendinopathy, and in some cases complete rest can slow recovery rather than help it. The right approach usually involves managing load carefully rather than stopping altogether. Your osteopath will advise you on what that looks like for your daily life and activity level.
Related Conditions
Plantar fasciitis: another common overload injury affecting the foot and heel, which often develops alongside Achilles tendinopathy or gets confused with it
Still Not Sure?
If you're in pain and wondering whether we can help, that's exactly why we're here. You don't need to know what the problem is. You don't need a referral. You just need to take the first step. Book online today or call 020 7733 9944 to speak to us.