Foot & ankle
Achilles tendinopathy
Back-of-heel pain with calf raises, running, or hills
What it means
The Achilles tendon transfers calf force to the heel. Midportion tendinopathy affects the tendon above the heel attachment. Insertional pain is at the attachment itself. Location matters when choosing how much ankle bend to use during exercise. [1]
What I check in the clinic
I ask what changed in your training and how your first steps feel the next morning. A heel raise gives us a repeatable check for pain, height, and repetitions. We can adjust the height, resistance, or range to match your starting point.
What the evidence says about care
Tendon-loading exercise is a main treatment for midportion symptoms. A trial found that some patients could continue sport using a pain-monitoring approach while in rehab. That does not establish the same plan for every injury, especially a suspected rupture. [1, 2]
Common questions
Why does my Achilles feel fine during a run and sore the next morning?
I’d ask about the run and how your first steps feel on a typical morning. We can use the response during activity and afterward to help decide what load to build toward.
A heel raise felt better here. What should I notice on my usual route?
Notice when the familiar soreness starts on the route you already use and how it feels the next morning. Compare that with how your calf felt during the clinic check.
Why are hills harder when I can handle the same distance on flat ground?
Tell me which hill brings it on and whether you feel it near the heel or higher up. That helps us choose what to compare during the exam.
What if I can do more heel raises but still can’t run at my usual pace?
Those give us two measures. I’d ask when faster running gets hard and use that with the heel raise and your response afterward to choose the next step.
What if I felt a pop and can’t push off?
Get medical assessment promptly. A sudden pop with a loss of push-off can be a sign of an Achilles tear. [3]
What should I bring to an evaluation?
Bring one example of a movement or activity you want back, along with any relevant imaging or treatment notes you already have.