The first steps out of bed are the worst. The back of your heel or lower calf feels stiff and sore, then loosens up as you walk around. Later in the day, after sitting or after activity, the ache and stiffness come back. You can’t think of an injury that started it. It just began and won’t go away.
This pattern is common with Achilles tendinopathy, an irritation of the large tendon that connects your calf muscles to your heel bone.
Where you feel it depends on the type:
- Midportion: the most common type. The pain is in the tendon itself, a few centimetres above the heel bone.
- Insertional: the pain is at the back of the heel bone itself, where the tendon attaches. This type often occurs along with irritation of the bursa next to the tendon. You can read more about that here: posterior calcaneal bursitis
What Causes Achilles Tendinopathy?
Understanding the cause is the key to getting better.
Achilles tendinopathy is usually a repetitive strain injury, meaning stress that builds up slowly over time rather than from one event. It often starts with small mechanical problems in the foot, ankle, and leg, such as:
- A stiff ankle or tight calf
- Stiff or restricted joints in the foot
- Muscle weakness
At first you don’t notice these problems because your body compensates. But the compensation changes how your foot and ankle move and shifts extra stress onto the Achilles tendon. This is the thick tendon that runs down the back of your lower leg and attaches to your heel. Over time, that stress can build into pain and tendon damage.
Our Approach: It’s Two Problems, Not One
It’s important to realize that Achilles tendinopathy isn’t one problem. It’s two.
Problem #1: The injured tendon. The tendon itself needs to heal and be rehabilitated. Our treatment combines:
- Shockwave therapy, which helps stimulate tissue healing. Research shows it can be an effective treatment for tendon problems.
- Progressive loading exercises, which are the foundation of tendon rehab. The exercises have to be challenging enough to trigger healing but not so hard that they flare the tendon up. That balance is why a customized program works better than generic exercises from YouTube or TikTok.
Problem #2: What caused it in the first place. This is the part that’s often missed, and it’s just as important. Most people, and many treatment plans, focus only on the pain. But if the stiff joints, tight muscles, and weakness that overloaded the tendon are never addressed, the tendon keeps getting stressed. That’s why these conditions can be so stubborn and keep coming back, even after a period of rest or treatment.
To find the cause, we perform a thorough exam to identify the specific muscle and joint restrictions and weaknesses behind your problem, then make correcting them a major part of your treatment plan. This includes:
- Active Release Technique (ART): a hands-on soft tissue method that releases tight, restricted muscles in the calf and foot that are hard to reach on your own
- Joint manipulation: to restore normal movement to stiff joints in the foot and ankle, when appropriate
- Home stretches and exercises
Treating both problems is what gives you the best chance of not just feeling better, but staying better.
What to Expect
Your first visit. We take a full history and perform a detailed exam. This confirms your diagnosis and uncovers what is driving the problem in your case. Only then do we build your treatment plan.
Timeline. This is not a quick fix. Tendons take time to heal, and the Achilles can be one of the slower ones. We can help it heal faster and better, but most plans run about 8-12 weeks, though this varies from person to person.
Visits. Treatments like ART and shockwave can’t be done at home, so we see you in the office, usually twice a week at first, then less often as you progress.
Home exercises. Your rehab program is prescribed in our office but done at home, typically about 30 minutes a day. Please consider this commitment before booking, since the exercises are a big part of why treatment works.
When Should You Get It Checked?
It’s worth having your heel and calf assessed if:
- The pain has lasted more than a couple of weeks
- It improves with rest but keeps coming back
- It’s starting to affect walking, exercise, or work
- The tendon feels thickened, or is tender to pinch
Tendon problems are generally easier to treat when they’re caught early, before months of compensation have built up.
Seek urgent medical care instead if you felt a sudden pop or snap at the back of your heel or calf, can’t rise onto your toes, can’t put weight on your foot, or notice significant swelling, bruising, or a gap in the tendon. These can be signs of a tear.
See How We Treat It
Here’s a short video on how we assess and treat foot pain in our office.
Ready to Get Started?
If heel or calf pain has been hanging around, we can help you find the cause and build a plan to fix it. Book your appointment here or call us at (905) 685-7227.