Achilles tendon pain: causes, assessment and loading

The Achilles tendon connects the calf muscles to the heel bone. Pain in the middle of the tendon, more than two centimetres above its attachment, is called midportion Achilles tendinopathy and is often referred to as Achilles tendonitis [1][2]. The guideline defines the condition as local pain in the tendon related to activities that load it [1].

The condition is common in runners. Pain at the attachment on the heel is a different condition and is not covered here. It is described on the page about Haglund's deformity.

The pain typically comes with loading, for example while running. It may ease somewhat during activity and get worse afterwards [2][3]. Many feel stiffness in the tendon for hours to days after a session, and morning stiffness is regarded as an early sign [2][3].

In more advanced cases there can be pain at rest as well [2][3].

The diagnosis is made mainly from the history and a clinical examination. The guideline is based on four criteria: symptoms in the middle of the tendon, pain triggered by loading, tenderness on pressure over the midportion, and possible local thickening [1].

Imaging is usually not necessary [1][3]. It may be relevant if the diagnosis is uncertain, if improvement fails to appear or the symptoms get worse, or when more invasive treatment is considered [1]. Findings must be interpreted together with the symptoms.

Loading exercise is the first choice, and the guideline gives this recommendation its highest grade of evidence. The exercises should be done as heavy as the individual tolerates, and at least three times a week [1]. Different types of loading gave similar results in the studies [1].

Complete rest is not recommended. You should stay active within what the pain allows, and be given information about what is happening in the tendon [1]. A temporary heel lift can be used as an addition [1][2].

Shockwave therapy has had effects similar to exercise alone in studies [1], and NHI describes that it can have an effect on pain during the first year [2]. Night splints and therapeutic ultrasound alone are not recommended [1].

It varies. With offloading, symptoms often improve within days to weeks, but rehabilitation often takes several months [2]. Exercise is recommended for up to three months [3]. In some cases the problems become chronic, and active athletes tend to have recurrences [2][3].

If you get a sudden snap and severe pain in the calf, and cannot stand on your toes, the tendon may have ruptured. You should then contact a doctor immediately [4].

If the symptoms do not improve after a period of adapted loading, or get worse, there is reason to have them assessed again [1].

A physiotherapist can examine where the pain is and what triggers it, and together with you make a plan for loading and rehabilitation. When the diagnosis is uncertain, diagnostic ultrasound can be used. If you are a runner, you can read more about running injuries.

What is Achilles tendonitis?

Pain in the Achilles tendon that comes with loading is called Achilles tendinopathy and is often referred to as Achilles tendonitis. The pain can be in the middle of the tendon or at its attachment on the heel [1][2].

How long does Achilles tendon pain last?

It varies. Symptoms often improve within days to weeks with offloading, but rehabilitation often takes several months [2].

Should I rest when my Achilles tendon hurts?

The guideline does not recommend complete rest. You should stay active within what the pain allows and train loading of the tendon [1].

How do I know if the Achilles tendon has ruptured?

A sudden snap and severe pain in the calf, and not being able to stand on your toes, can indicate it. Contact a doctor immediately [4].

The page about Haglund's deformity describes pain at the tendon attachment on the heel. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Chimenti RL, Neville C, Houck J, Cuddeford T, Carreira D, Martin RL. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision, 2024. J Orthop Sports Phys Ther. 2024;54(12):CPG1–CPG32. doi:10.2519/jospt.2024.0302. Link

2. Akillessenebetennelse (Achilles tendonitis). NHI.no. Last updated 15 October 2024. Link

3. Lind M. Akillestendinose. Lægehandbøgen, sundhed.dk. Revised 9 October 2026. Link

4. Lind M. Akillesseneruptur (brist af akillessenen). Patienthåndbøgen, sundhed.dk. Last updated 24 September 2025. Link