Achilles Tendon Pain: Causes, the Exercises That Help and How Long Recovery Takes

Achilles pain is often stiffest first thing in the morning and eases as you warm up, which tempts people to keep pushing through it. The tendon needs the right kind of load to heal: not complete rest, and not more of what caused it. Here’s what works.

Imagine you’ve just started running again to get fit, or you’ve switched to a job where you’re on your feet all day. Every morning, your first steps out of bed feel like your heel cord is made of wire. By mid-morning it eases, but after a long shift it aches again. That pattern is classic Achilles tendinopathy.

Common causes

• A sudden increase in running, walking, hills or jumping
• Long hours standing or walking on hard floors
• Tight or weak calf muscles
• Unsupportive footwear
• Age, being overweight, diabetes, and some antibiotics called fluoroquinolones (such as ciprofloxacin)

Exercises with the best evidence

Gradually loading the tendon helps it remodel and get stronger. A physiotherapist can tailor a plan, but common exercises include:

• Calf raises: rise up onto your toes on both feet and lower slowly. Progress to one foot, then off the edge of a step.
• Slow, heavy calf raises with a backpack or weights as you get stronger
• Bent-knee calf raises to work the deeper calf muscle

Some discomfort during exercise is acceptable (around 3 to 5 out of 10), as long as it settles by the next morning. Reduce, but don’t stop, aggravating activities. Heel raises in your shoes can ease pain short term.

How long recovery takes

Tendons are slow to heal. Most people improve over about three to six months of consistent exercise. Steroid injections into the Achilles are generally avoided because they can weaken the tendon. If things aren’t improving after a few months, ask about other options, such as shockwave therapy.

But could it be a rupture?

Get urgent help if you felt a sudden snap or a feeling of being kicked in the back of the ankle, followed by pain, swelling and difficulty walking or standing on tiptoe. A ruptured Achilles needs treatment quickly, either a special boot or surgery, for the best recovery.

Sources: NHS (Achilles tendinopathy; Achilles tendon rupture), American Academy of Orthopaedic Surgeons, Chartered Society of Physiotherapy, US Food and Drug Administration warning on fluoroquinolone antibiotics. This guide is for general information and does not replace advice from your own nurse, doctor or physiotherapist.