Achilles Tendinopathy

Common Symptoms

• Aching or burning pain at the back of the heel or a few centimeters above it
• Morning stiffness in the tendon that eases somewhat with movement
• Pain that worsens with running, jumping, or pushing off the foot
• A thickened, tender, or "lumpy" feeling along the tendon
• Pain that returns after periods of increased activity

Why It Happens

The Achilles tendon handles enormous repetitive load, particularly during running, jumping, and pushing off the foot. Tendinopathy develops when the rate of microscopic strain outpaces the tendon's ability to remodel and adapt, leading to a mix of disorganized collagen structure and, in some cases, small blood vessel and nerve ingrowth associated with pain.

Why It Can Become Persistent

Tendon tissue heals more slowly than muscle, and because the Achilles is loaded with nearly every step, it's difficult to fully offload while staying active. Training errors (rapid increases in mileage or intensity), calf tightness, footwear, and biomechanics can all keep reinjuring the area faster than it can adapt — which is part of why Achilles tendinopathy is notorious for lingering for months.

Who Commonly Gets It

Runners are classically affected, but Achilles tendinopathy is also common in recreational athletes who play sports involving running and jumping, as well as in adults who have had a recent increase in activity or who are returning to exercise after time off.

How It Is Usually Diagnosed

Diagnosis is usually clinical: history, palpation of the tendon for tenderness and thickening, and functional tests such as single-leg heel raises. Ultrasound or MRI can help confirm the diagnosis and distinguish insertional tendinopathy (at the heel bone) from midportion tendinopathy (a few centimeters above it) when the distinction isn't clear on exam, since it can affect treatment.

Traditional Treatment Options

• Eccentric/heavy-slow-resistance loading program: A structured, progressive calf-loading exercise program is generally considered a first-line treatment with strong evidence behind it.
• Activity modification: Temporarily adjusting training volume or type to reduce aggravating load.
• Physical therapy: Guided rehabilitation combining loading progression, mobility work, and gradual return to activity.
• Heel lifts or footwear changes: Can reduce strain on the tendon during the loading phase, especially for insertional tendinopathy.
• NSAIDs: Sometimes used short-term for symptom control.

Why Someone Might Start Looking for Another Option

A calf-loading program helps many people, but it takes consistency over weeks to months, and a meaningful number of patients still have symptoms after completing a full course. That's often when shockwave therapy enters the conversation, particularly for tendinopathy that has persisted beyond the typical expected timeline.

Where Shockwave Therapy May Fit

Shockwave therapy has been studied specifically for Achilles tendinopathy, often alongside — not instead of — a loading exercise program. It's non-invasive and doesn't require the tendon to be immobilized. It's worth being direct about one nuance in the research: the evidence is stronger and more consistent for midportion Achilles tendinopathy than for insertional tendinopathy (at the heel bone). More recent studies comparing the two locations have found less durable results for insertional disease, and at least one newer comparative study found no long-term advantage over conservative treatment specifically for chronic insertional Achilles tendinopathy. Where your tendinopathy is located is one of the things your evaluation should clarify before treatment is discussed.

How Shockwave Treatment Works for This Area

Focused acoustic pressure waves are directed at the affected portion of the tendon. Research has evaluated its effects on pain and function in chronic Achilles tendinopathy; see What Research Says below for the specific evidence and its limitations.

What the Treatment Feels Like

Patients typically describe a firm tapping or pressure sensation, with some soreness directly over the tender part of the tendon. Sessions are brief, and most patients are able to walk out and resume normal daily activity the same day, per your provider's guidance.

What Happens During Your First Visit

Your visit begins with a provider evaluation focused on your history and a physical exam relevant to your complaint. If shockwave therapy is determined to be clinically appropriate, your first treatment can typically be provided the same visit. See our What to Expect page for the full walkthrough.

Who May Not Be Appropriate

• Suspected Achilles tendon tear/rupture, which requires prompt medical evaluation rather than shockwave therapy
• Active infection, open wounds, or certain bone conditions at the treatment site
• Certain circulatory, neurological, or bleeding-related conditions, per your provider's screening
• Pregnancy, in the treatment area, unless specifically cleared by your provider

This list is not exhaustive. Your provider will screen for contraindications during your evaluation.