Stiffness at the back of your heel first thing in the morning, an ache when you start a walk or run, or soreness on the stairs. Achilles tendon pain can be frustrating, especially if you like to stay active. The good news is that it usually responds well to the right kind of strength work, and most people can keep active while it settles.

What the Achilles tendon is

Your Achilles tendon is the thick cord at the back of your ankle that connects your calf muscles to your heel bone. It is the strongest tendon in your body, and it acts like a spring when you walk, run and jump.

Achilles pain usually happens when the tendon is loaded more than it can comfortably cope with, like a jump in running distance, more hills, a new activity or a change in footwear. The tendon becomes sensitive, and you may feel pain, stiffness or tenderness, either in the middle of the tendon or where it attaches to your heel.

Why the tendon gets sore

Tendons adapt slowly. When load rises faster than they can keep up with, they become sensitive. Rest may ease the pain for a while, but tendons that are rested lose some of their ability to cope, so the pain often returns as soon as you do more.

That is why the most helpful approach is usually to keep the tendon working at a level it can handle, while building its strength gradually.

If you have been given advice or exercises by a physiotherapist, keep following that.

Calf strengthening

Strength work is at the heart of managing Achilles pain. Research using slow, controlled heel raise programmes over around three months has found that many people with long-term Achilles pain were able to return to their usual activities.

Something to try three or four times a week:

• Heel raises on both feet. Hold onto a worktop, rise onto your toes, pause, then lower slowly over about three seconds.
• Single-leg heel raises. As both-leg raises feel easier, rise on both feet and lower on the sore leg alone.
• Bent-knee heel raises. Same movement with your knees slightly bent, to work the deeper calf muscle.

If you would like to follow along, VIDA has short videos of heel raises you can use at your own pace. Start with a comfortable number and build up over weeks.

If the pain is right where the tendon meets your heel, doing heel raises on flat ground rather than off the edge of a step tends to be more comfortable.

Managing activity

Most people do not need to stop being active. Research has found that people with Achilles pain who kept active, while keeping their pain within agreed limits, recovered just as well as those who stopped, and they stayed active throughout.

A simple guide:

• A mild ache during activity that settles within an hour or so is usually fine.
• If your tendon is stiffer or sorer the next morning, ease back the next session.
• Build up one thing at a time, like distance, speed or hills.

Swimming and cycling are good ways to stay active on days your tendon prefers less load.

Easing morning stiffness

Achilles stiffness is often the worst first thing. Before you get up, you can gently point and flex your feet and circle your ankles a few times. Taking your first few steps slowly can help. A warm shower can help a stiff tendon loosen too.

Footwear

Shoes with a small heel and good cushioning tend to feel more comfortable than very flat shoes. If the back of your shoe presses on a sore spot at your heel, a different pair or a softer heel counter can help. If you are changing to flatter or more minimal shoes, doing so gradually gives the tendon time to adapt.

When to get it checked

If you feel a sudden snap or kick at the back of your heel and find it hard to push off when walking, it is worth getting it checked straight away.

Your VIDA pain check-in can help you notice how your tendon responds as you build strength.

What to take away

• Achilles pain usually responds well to gradual strengthening.
• Rest alone tends not to help in the long term.
• Build calf strength with slow heel raises, three or four times a week.
• Keep active within comfortable limits, using the next-morning check as a guide.
• Choose shoes with a small heel and good cushioning.

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