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The Ultimate Runner’s Guide to Achilles Tendon Injuries

Achilles tendon injuries can make running painful and eventually, almost impossible. We explain what causes achilles tendonitis, and how you can strengthen yours to be pain free, and get back to running quickly.This is most likely an article you don’t want to read.

Here’s why:

Achilles tendon injuries can be stubborn, painful and depressing. If you’re reading this, then you likely have one. Luckily, we’re here to help.

This guide will explain why achilles tendon issues occur, and what you can do to limit the time it takes to heal it if you are suffering from achilles tendon aching, soreness, creaking or heel pain.

The Achilles tendon is the thickest and strongest tendon in your body, connecting your calf muscles to the back of your heel.

Virtually all of the force generated when you “toe off” the ground during running is transmitted by the Achilles, and this force can be as much as three times your body weight. And the faster you run, the more strain you put on the Achilles tendon.

As such, it’s prone to injury in many runners, but particularly those who do a lot of speed training, uphill running, or use a forefoot-striking style. Achilles tendon injuries account for 5-12% of all running injuries, and occur disproportionately in men.

This may be because of the faster absolute speeds men tend to train at, or may be due to other biomechanical factors.

Achilles tendonitis typically starts off as a dull stiffness in the tendon, which gradually goes away as the area gets warmed up. It may get worse with faster running, uphill running, or when wearing spikes and other low-heeled running shoes.

If you continue to train on it, the pain in the tendon will be more sharp and you will feel it more often, eventually impeding your ability even to jog lightly.

About two-thirds of Achilles tendonitis cases occur at the “midpoint” of the tendon, a few inches above the heel. The rest are mostly cases of “insertional” Achilles tendonitis, which occurs within an inch or so of the heelbone. Insertional Achilles tendonitis tends to be more difficult to get rid of, often because the bursa, a small fluid-filled sac right behind the tendon, can become irritated as well.

The common causes of Achilles tendonitis in runners

Here’s the deal:

The causes of Achilles tendonitis all appear to be related to excessive stress being transmitted through the tendon. Weak calf muscles, poor ankle range of motion, and excessive pronation have all been connected with the development of Achilles problems.The upshot is that all of these factors, plus training volume and so on, result in damage to the tendon.

While the term “tendonitis” implies that inflammation (-itis) is the root cause of the problem, in fact, the true cause is real, physical damage to the fibers of the Achilles tendon itself.

Much like a bungee cord is made up of tiny strands of rubber aligned together, tendons are comprised of small fiber-like proteins called collagen. Pain in the Achilles tendon is a result of damage to the collagen. Because of this, treatment options should start with ways to address this.

How can I treat my achilles tendon pain?

For a long time, researchers and doctors muddled about trying to address factors like calf strength & tightness, ankle range of motion, and pronation, assuming that the Achilles tendon would heal itself once these factors were corrected.

Unfortunately, it seems that the thick tendons of the body do not heal as rapidly or completely as we’d like.

The cause of this seems to be the collagen fibers:

When a tendon is damaged, collagen fibers are ruptured. The body is able to lay down new fibers to replace the damaged ones, but it does so in a rather disorganized way. The new collagen fibers look much like a mess of spaghetti when viewed on a microscope, in contrast to the smooth, aligned appearance that healthy tendon fibers have.

Unfortunately, it gets worse:

While we might propose that runners do calf stretching to loosen up their calf muscles and increase their ankle range of motion, this often does more harm than good—tugging aggressively on the damaged tendon fibers is much like pulling on either end of a knotted rope.

Instead, the main objective in treating Achilles tendon injuries should be healing the damaged tendon. The exercise of choice is the eccentric heel drop, which has an impressive research pedigree backing its use.

How does the eccentric heel drop help my achilles get better faster?

The strength protocol consists of two exercises: a straight-kneed and a bent-kneed eccentric heel drop.

The protocol calls for three sets of fifteen heel drops, both bent-kneed and straight-kneed, twice a day for twelve weeks.

Standing on a step with your ankles plantarflexed (at the top of a “calf raise”), shift all of your weight onto the injured leg.

Slowly use your calf muscles to lower your body down, dropping your heel beneath your forefoot. Use your uninjured leg to return to the “up” position. Do not use the injured side to get back to the “up” position!

The exercise is designed to cause some pain, and you are encouraged to continue doing it even with moderate discomfort. You should stop if the pain is excruciating, however.

Once you are able to do the heel drops without any pain, progressively add weight using a backpack. If you are unlucky enough to have Achilles tendon problems on both sides, use a step to help you get back to the “up” position, using your quads instead of your calves to return up.

What’s the bottom line?

The eccentric exercises are thought to selectively damage the Achilles tendon, stripping away the misaligned tendon fibers and allowing the body to lay down new fibers that are closer in alignment to the healthy collagen in the tendon.

This is why moderate pain during the exercises is a good thing, and why adding weight over time is necessary to progressively strengthen the tendon.

Exercise 1: The straight-knee eccentric heel drop.


eccentric heel drops achilles tendonitis

In this picture, the injured side is the left leg. Note that the right leg is used to return to the “up” position. This exercise is one of two used in cases of midpoint Achilles tendonitis. Once you can perform this exercise pain-free, add resistance using weights in a backpack.

Exercise 2: The bent knee eccentric heel drop.


eccentric heel drops bent leg achilles tendonitis

As with exercise 1, the opposite leg is used to return to the “up” position. This time, bend your leg at the knee and slowly lower yourself down. This is the second exercise for midpoint Achilles tendonitis. Add weight when you can do it pain free.

Exercise 3: Modifications for insertional Achilles tendonitis


eccentric heel drops insertional achilles tendonitis

Exercise 3: the flat-ground eccentric heel drop. This exercise is used for cases of insertional Achilles tendonitis, replacing exercises 1 & 2. Like the exercises for midpoint Achilles tendonitis, use the opposite leg to return to the “up” position and add weight once you can do it pain-free.

In the case of insertional Achilles tendonitis, the protocol is modified a bit: the exercise is done on flat ground, and only the straight-legged variant is done. All other aspects are identical (3×15 twice daily, adding weight, and so on).

Exclusive bonus: Download our full Achilles Injury Prevention Routine. It’s a PDF with images and descriptions of the 10 most effective prevention and rehab exercises for runners with Achilles issues. Download yours for free here.

Is there anything else I can do to speed healing?

While you are addressing the damage to the tendon fibers through eccentric heel drops, there are some steps you can take to help ameliorate some of the other contributing factors to your injury.

  • While calf tightness and ankle range of motion are legitimate concerns, I still don’t think that aggressive calf stretching is an ideal solution, because of the tugging action on the tendon. Instead, try foam rolling your calves and applying a warm water bag to the muscle (but avoid heating the tendon!). Foam rolling your calf muscles can loosen them up without tugging too much on the Achilles tendon. Just make sure you are not making the 4 most common mistakes runners make when foam rolling.
  • You can also stretch out your shins by leaning back in a kneeling stance to aid ankle range of motion.
  • Footwear concerns should also be addressed at this point. If you have been wearing low-heeled “minimal” shoes, racing flats, or spikes, you ought to stick to more traditional shoes with a higher heel until your tendon is healthy again. Once you’ve healed up, you can gradually do some running in low-heeled shoes or even barefoot (on grass) to help accustom your Achilles to moving through its full range of motion. Poor casual footwear choices should not be overlooked too, especially for women. Some shoes can also put pressure on the back of your heel, irritating the insertion of the tendon. Generally, the closer a shoe is to looking and feeling like a “running shoe,” the better it is for your foot.
  • Doctors and podiatrist may be keen to have you try out a custom orthotic to treat your Achilles problems. While it might be worth a shot, there isn’t a whole lot of scientific evidence backing their use in this case. Orthotics don’t reliably alter pronation, and even if they do, it’s uncertain as to whether this will increase or decrease stress on the Achilles.

Outline of treatment

Conservative treatments

These are cheap, easy to perform treatments that you can do it home in your own time. You should try to do as many of these as possible each day.

  • Eccentric heel drops – 3 sets of 15 reps, twice per day for 12 weeks (if you only do one thing, do this!)
  • Icing after each run
  • Heating before each run with warm water or heating pack
  • Contrast bath during the day – take two small buckets/trash cans and fill one with hot (hot bath temp) water and the other with ice water (cold enough so some ice still doesn’t melt) and put your whole leg (up to the calf) in the cold. Hold for 5 minutes and then switch to the hot for 5 minutes. Repeat 2 or 3 times, ending with cold. This helps rush blood in and out of the area, which facilitates healing
  • Don’t take anti-inflammatory like Advil or ibuprofen. These stop the body’s natural healing agents and we want as much natural healing to occur as possible.
  • Avoid excessive stretching – only very light, easy stretching until healed
  • Heel lifts are a possible temporary solution. They restrict the Achilles’ range of motion, so can be helpful to get over the initial hump of the injury, but should be taken out after you are recovering.
  • Switch to more supportive or traditional running shoes (higher heels) during your runs and while walking around until your pain is completely gone, and avoid flats and high heels!
  • Sleep in a Strassburg sock or nightsplint to gently stretch the Achilles while sleeping.

Aggressive treatments

These treatments are a little more expensive or time consuming and are only suggested for if you suffer from chronic Achilles pain or the conservative treatments are not working for you.

  • A custom orthotic might help alleviate the pain from excessive pronation. This is not a proven treatment, but for those runners who respond to orthotics, it can help.
  • Iontophoresis with dexamathasone. This is a treatment offered by physical therapists that involves propelling anti-inflammatory steroids into the tendon. You need a prescription and a physical therapist to administer the treatment, but research has shown the potential to have a positive effect on the treatment of Achilles issues.

Strengthening and prevention

  1. Eccentric heel drops
  2. Ankle strengthening and mobility exercises
  3. Achilles rehab exercises

When can I return to running?

You can still run during this twelve-week period, but only if your Achilles does not flare up while doing so.

Use warm water to heat up the tendon before you run, and apply ice afterwards, even once you’ve started feeling better. Using a foam roller and hot water packs to loosen up your calves in the morning and at night is also not a bad idea, and don’t forget to take a look at what you’re wearing in your daily life.

If you have insertional Achilles tendonitis, use the modified flat eccentric heel drop exercise instead of the two variants off a step.

A custom orthotic or heel lift may be helpful, but should not be a first-line treatment option.

Exclusive bonus: Download our full Achilles Injury Prevention Routine. It’s a PDF with images and descriptions of the 10 most effective prevention and rehab exercises for runners with Achilles issues. Download yours for free here.

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1. Taunton, J.; Ryan, M.; Clement, D.; McKenzie, D.; Lloyd-Smith, D.; Zumbo, B., A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 2002, 36, 95-101.2.
2. Marti, B.; Vader, J. P.; Minder, C. E.; Abelin, T., On the epidemiology of running injuries-the 1984 Bern Grand-Prix study. The American Journal of Sports Medicine 1988, 16(3), 285-294.3.
3. Maffulli, N.; Wong, J.; Almekinders, L. C., Types and epidemiology of tendinopathy. Clinics in Sports Medicine 2003, 22(4), 675-692.4.
4. Ryan, M.; Grau, S.; Krauss, I.; Maiwald, C.; Taunton, J. E.; Horstmann, T., Kinematic analysis of runners with Achilles mid-portion tendinopathy. Foot & Ankle International 2009, 30(12), 1190-1195.5.
5. Alfredson, H.; Pietilä, T.; Jonsson, P.; Lorentzon, R., Heavy-load eccentric calf muscle training for the treatment of chronic achilles tendonitis. American Journal of Sports Medicine 1998, 26 (3), 360-365.
6. Jonsson, P.; Alfredson, H.; Sunding, K.; Fahlström, M.; Cook, J., New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. British Journal of Sports Medicine 2008, 42 (9), 746-749.
7. Nigg, B., The Role of Impact Forces and Foot Pronation: A New Paradigm. Clinical Journal of Sports Medicine 2001, (11), 2-9.
8. Neeter, C.; Thomeé, R.; Silbernagel, K.; Thomeé, P.; Karlsson, J., Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain. Scandanavian Journal of Medicine & Science in Sports 2003, 13 (6), 376-382.

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176 Responses on “The Ultimate Runner’s Guide to Achilles Tendon Injuries

  1. This is a great summary. I dealt with Achilles tendinitis for several months earlier this year and tried much of what you mention here, both conservative and aggressive approaches. While most of my experience is consistent with what you have written, I think going against the prevailing wisdom in certain areas actually promoted my recovery. I found not only custom orthotics to be a waste of money, but heel lifts also aggravated the situation for me – in fact, the more time I spent barefoot or in my Nike Free’s, the better I felt. Shoes with a “traditional” heel-to-toe drop made things worse. The night splint definitely helped, but what finally got me back on the streets was ART treatment.
    My chiropractor stated that running more miles can actually help one overcome AT by thickening the tendon and making it more able to “work around” damaged fibers, but I haven’t investigated whether there is research to support this.
    I spent most of this marathon season on the edge of recurrence, and finally found that active isolated stretching and foam rolling were the best tools for staying “healthy enough” to train fully. Now I’m counting on your Achilles routine (and a bit of Artemis) to get truly healthy for next year.

    • I also tried eccentric training several times for about two years. The issue was temporary resolved- but always came back when I increased my running. Desperately, I finally switched to forefoot striking and shoes with lower heels. Problem solved. I have now been symptom free for a year.

    • I also have insertional AT. It was pretty bad when I first started running three years ago due to some dumb training decisions. I took time off, got PT and it hasn’t been as bad since, but is still there. I ran a second marathon this year and I have to say my IAT has been less sort this year. My training was harder this year, and this may support the theory of healing through strengthening.

    • Your comments make me feel a bit better about my assumption of my AT issue. I have ran for years now in a minimalist shoe although during that stretch I had a bit of inconsistency. I’ve been back running consistently (4-5 times per week) for about 6 months now and decided to try incorporating more of a traditional trainer into my routine with half my runs coming with the trainers and half with a minimalist. Just two weeks into that I am having Achilles pain in my left leg. I had decided to go all minimalist this week and see if it helped, but I am afraid I might be too far gone for that alone to get me back 100 percent.

      • Glad we were able to help John. If you are interested in the minimalist style shoe type, you may enjoy our podcast with Harvard professor, Dan Lieberman, you can check it out here: http://runnersconnect.net/rc47. Keep us posted, and good luck with your return to running. Be careful with how quickly you change your shoes, any changes within running should be made gradually. Hope this helps!

    • I have insertional Achilles tendonitis. Started the eccentric heel exercises daily and within one day the pain decreased and continues to do so. I take an anti-inflammatory when walking only 3 times per week at this stage, and not at other times. Pain decreasing daily. YAY!!!

      • Hi Janette, sorry to hear about your achilles problems. We are glad to hear that things are moving in the right direction. Our guide does work :) Keep it up, and hopefully by now you are feeling much better!

  2. Thank you for pointing out the difference between insertional and midpoint Achilles tendonitis. It’s a distinction that is often neglected and has important treatment implications. I was recently told I have insertional Achilles tendonitis, which probably explains why weeks of doing the traditional eccentric heel drops hasn’t helped much. I recently modified the heel drops, as you suggest, by doing them on flat ground, and am hopeful I will now finally see improvement.

    • Hi Jeanne,

      I am glad the article was helpful and the specific advice on the insertional tendonitis gave you some new strategies to attack the injury. I hope it clears up quickly for you. Best of luck!

  3. I’ve been following the rehab protocol for about 4 weeks. I’ve been gradually increasing the weight without experiencing any pain during the exercise, however, about an houjr after I’m finished, I start experiencing some pain that varies in intensity from about 1 through 4 on a scale of 10. The pain remains for the rest of the day but it’s gone when I awake in the morning. Any explanation as to what is going on? Do you think I should continue with the program?
    Thanks for any extra help you could give me.

    • Hmm, tough to say exactly, but I think what might be happening is that the tendon fibers are restructuring themselves after you do the lifts. It’s a good thing, since that’s what you want, but the pain is likely the result. I would continue with the program, but you also might want to see a PT, just to be safe.

  4. Hey,

    I have been struggling with insertional AT for about a year now and have been trying to do everything I can to get rid of the swelling and pain for the past 4 months. I play basketball and do a lot of basketball related drills (plyometrics and strength training) that most likely have contributed to my AT. I sleep in night splints and have drastically limited my activity in the last four months however, despite this rest I still have swelling and slight pain when I play. Its significantly better than when I played on it four months ago but I am doing a lot less than I did back then. I’m reluctant to continue playing through the swelling because I don’t want to back track in my recovery. I am only 21 so its very discouraging that my body is rebelling against my typical physical activity. Is complete rest beneficial in any way because relative rest didn’t seem to work? Does insertional AT ever TRULY go away?

    • Sorry to hear you’re having such problems, Alex. I would suggest seeing a podiatrist or PT. It’s possible you have some interference between the heel bone and the achilles. Sometimes, this causes rubbing/tearing between the two and can result in consistent swelling like you’re experiencing.

  5. I’ve been diagnosed with achilles tendonitis on my left ankle before and now I’m having similar symptoms again. This time I’ve begun to question whether tendonitis is the actual condition I’m having. For example, I have no swelling of any kind around the tendon, no crepitation and the area around the tendon isn’t tender even if I squeeze it doesn’t hurt at all. Running doesn’t hurt either. But I do feel something is not right with my ankle when I’m going about my daily business. The feeling isn’t pain it’s more like a mild discomfort. It’s transient in nature.

    I stumbled on this youtube video (http://www.youtube.com/watch?v=DgHoePuZaPw) where they explain that often times similar symptoms can be caused by tightness of the soleus muscle and recommend massaging the calf using a rolling pin. I’ve tried this and indeed it does make the feeling go away. In fact, just a little massaging of the calves does the trick, but the discomfort always returns after a while. What is interesting about the rolling pin is that after an exercise you can use it to locate painful spots on the calf muscles. This is interesting because the discomfort I feel on my achilles tendon correlates with my calf having these painful spots.

    So, is it likely that this is a mild case of achilles tenditinis or a problem with my calf muscles? What do you think?

    • Hi Jani.
      I came across your post and was astound after reading how your description of your Achilles issue is exactly how I would describe mine. I have seen drs/podiatrist/pt and they all look at me like I am insane when I describe my issue, almost as to say “well if you don’t have any pain your fine” but I know my Achilles is far from fine. Anyways I was just wondering if you have had any luck resolving your Achilles issue as I’m almost certain we are dealing with the same issue. Please reply when you get a chance, your response is greatly appreciated.
      Thanks in advance,

  6. Yo.
    Thanks for all of your advice. So this insertion tendosis is the worst running injury I’ve ever had (10+ yrs of running 60 mpw). I’ve tried everything without success: eccentrics for months, physical therapy ART, nitro, kineso tapping, total rest, heel lifts. MRI shows less than 5% tear with retro calcaneal bursitis. There really appears to be no Improvement, and just a certain stepping or jogging shortly can exacerbate the tendon which remains symptomatic for days (typically only with gentle stretching). My sports doc (who is also a runner), states it can take up to 9-12 months (holy sh#%). Do you or anyone know any better the Natural History of this disease (insertional), better than “it can take 9-12months”. I mean why 12 months and not 24? What is the median months of return to running? Because at this point I’m going to have to drop a grand on a bike and kiss running goodbye, which would really suck. Anyway, hope all you suffers heal as quick as possible.

    • I have had insertional Achilles tendonopathy since last November. My GP gave me Achilles exercises which, after 6 weeks, did not help at all. I then saw the physiotherapist who told me that the exercises I had been given only made it worse! He has given me the exercises recommended for insertional AT and, though painful, appear to be helping. This week I was actually able to walk the dog with my husband, something I haven’t been able to do for months. No-one has given me a time frame for getting better.

    • I got IAT for the second time now, because of minimalist transistion to fast. The first time it took from sept 2011 to April 2012 to heal. I tried lots of stuff and I’m still not sure what made the difference. Maybe just time was necessary. One error for sure I was making was running everyday, the injury just came back, rest for week and try again. When I started running once every two days, it took 2 weeks and I was fully cured! But I had months of Eccentric calf drop done and I’m sure it help a lot. During the summer 2012 I overtrained again a got a stress fracture on the other foot, but my AT was OK. This winter I got IAT again with just 30Km/week training? Is it the cold? I was running twice a day to go to work, is that a nono? Anyway it’s two months now and still no improvement.

      Wish you all good luck.

      • I’ve had insertional tendinitis for over 3 years and have been sent through a raft of incorrect diagnoses. I initially went to a podiatrist who gave me some stretches to perform (eccentric steps 1 & 2 from the directions here) and saw no improvement………obviously seeing as the diagnosis was incorrect. Later after completely stuffing my achilles up on hardfloor courts, i went to the GP who said i had IT and needed to see a physio or sports podiatrist to get sorted. I went to the physio and all seems to be recovering well for the first time in 3 years. That bulge on my right heel is also growing smaller. He said it would take 6 months plus to get it back to health again though.

        Time did me no favours with IT. Only made it worse. Accupuncture was also relieving of the pain symptoms and for improved blood flow to the area. Heat packs have also been helpful.

  7. Hi, I have (midpoint) archilles tendonitis and the only advice I have been given is to take painkillers and rest it i.e. stop running. I have an upcoming charity run which I still want to take part in and so am unwilling to just ‘rest’ my foot.
    Every step i take on my bad foot results in sharp pain which increases in intensity as i run and even more so after a run. By continuing to run do I risk further damage to the tendon?
    Are there any other techniques you could suggest which will allow me to continue training with less pain?

    Many thanks, Abs

  8. I am now using a walker control after having a cast for 30 days. not sure what type i havebut it seems it will take longer time than usual since I am over forty an I am afraid that I have stopped training and started gaining weight.. any advice please

  9. I have pain just above my right heel and under my heel in the morning. I like to train in the morning but it takes time for my Achilles to warm up I do stretching exercises then after about a mile I’m pain free then after my run the pain comes back but not straight away do you have any suggestions what to do .i recently run a half marathon then I’ve rested for 3weeks I tried a short run but the pain has started to trouble me again

  10. How far down should you go re: the eccentric heel drops? Until there’s resistance, as in, you can’t go any further? Or should you stop before that? Thanks for the helpful information!!

    • Good question. I would say that you should go until you feel a good stretch and then stop there. You shouldn’t try to force it further than what feels comfortable.

      • Thanks for the swift reply! I hope you don’t mind three more quick questions:

        1. Am I supposed to feel the stretch primarily in my calves? That’s what’s happening at the moment.

        2. How slow is “slowly”? I was dropping my heel so slowly that my legs were very sore after 15 reps, so I’m assuming that’s too slow, but I don’t want to go too fast, either. I’ve been dealing with this issue for months now and don’t want to re-injure anything.

        3. I’m feeling a good stretch with the straight-leg version and no stretch with the bent-leg version. Is that a good sign? A bad sign? Am I doing something wrong?

        Sorry to pepper you with so many questions! This treatment is so promising, though, that I want to do it right. Thanks again,


  11. I have had insertional Achilles tendonitis for 2 years now. I am told by the surgeon / ankle specialist I saw that surgery is really the only solution. However the success rate of surgery is not too encouraging.
    Has anyone else had surgery for this condition? What was the outcome?
    I wore a cast for 6 weeks and was pain free for 2 months afterwards but the pain then returned.
    Does anyone recommend shoes (not running shoes – just for everyday wear)??

    • Holly,

      I’m in the a similar boat. I’ve now had IAT for roughly 2.5 years. I took a full year off of running the last time, yet I still can’t run more than twice a week (12 miles total, tops) for fear of it returning full fledged. Currently, my heel aches for a few days after a run and I just wait for it to subside before attempting to get out there again. I’m at a loss, I was thinking surgery was the only answer at this point, but reading your story really discourages me.

      Shoes that are almost over cushioned in the heel seem to make my IAT feel better. I have some Asics Blur33’s that I wear around when not a work or not running.

      As far as running shoes go, I’d like to get some advice, as well. When I originally got IAT I always wore light-weight training shoes and was a heel-to-toe striker. After the year off of running I tried to switch running styles to a mid-foot or fore-foot strike, also in light-weight training shoes. Neither style seemed to make a difference, as my IAT returned after a few months of training. I’ve recently purchased a pair of Newtons and I like them a lot (don’t have to think about mid-foot strike as they almost force you to mid-foot anyway), but they don’t seem to be helping me anymore than my previous shoes (Saucony Kinvara’s).

      • Whit,

        I’m sorry to discourage you re surgery! I think the stats are that for 70% surgery is successful; 20% get no benefit and 10% the pain becomes worse. So quite good stats in a sense! But having trained as a nurse I know that bone can often grow back after being cut away and I guess I just feel that surgery is a last resort thing – for me that is.
        But it would be great to hear from those who have had it.

        I wore an aircast for 6 weeks to give it complete rest and then saw a great physio and began stretching exercises for the Achilles’ tendon. After a while I started doing eccentric heel raises on a step but this brought pain and now (3 months since aircast came off) the pain has returned – largely through just living life! – walking on pavements etc etc (haven’t done any running). I think my mistake has been not having good footwear and at times wearing flat shoes.

        I have just bought a pair of Asics GT 1000 and I noticed the difference immediately. The pain decreased considerably and I didn’t hobble along anymore!
        So this has given me renewed hope. Having achieved a 3 month period pain free and now seeing the difference raising my heel makes (in order to stop the tendon rubbing on the heel,spurs) I have renewed hope. I’ll also start doing the flat ground eccentric heel raises.
        i think swimming may have helped – I did some for a couple of weeks . I may start doing that regularly ( not my favourite thing!)

        Best wishes

  12. not clear exactly “where” insertional achilles is located along the achilles – can U clarify with a diagram or clearer description – I’m unsure as to whether my injury is insertional or mid point ie where exactly is mid point?

  13. I have heard from a lot of others as well that the custom orthotics are a waste of money. But a lot of running stores have advised me to get insoles in addition to the structured shoes (Asics GT 2170) I own. Have you, or any of the readers, had any luck with them?

  14. I have had insertional achilles tendonosis for 2 1/2 years. I wrote about it in an above post. I just wanted to say that it seems to be cured after seeing a Podiatrist.

    He told me that the problem was the subtalar joint in my foot which was slightly dislocated. He manipulated it back into position and it’s better! I can’t believe it – feel like I’ve got my life back after 2 1/2 years of limping around. I’d seen a top surgeon and two physical therapists none of whom saw what it was. The Achilles’ tendon problem was a symptom not the root cause. The surgeon had said I needed surgery on my Achilles’ tendon/ heel bone – SO glad I declined his suggestion.

    So just to say if you have insertional achilles tendonitis see a Podiatrist – just to get another opinion. (They specialise in feet and ankles.) I’m sure most IAT is not caused by a dislodged talus bone but it’s just worth checking out as none of the specialist recognised it.

  15. I have been suffering from midpoint tendinitis for the last 3 weeks when should i start the heel drop protocol – I ran 10k on Sunday and Monday there was pain that gave me a limp. Tuesday that pain has reduced i get through 3-5 reps before i think i should stop (there is pain in every rep but builds per rep)
    I don’t want to be out of action for too long as i have a half marathon in September and don’t want this achilles pain to affect my build up for that.
    Should i wait until the pain lessens before doing the protocol or do as much as i can now and build up?

  16. Hi there , i have just started a running club and although at present i am only doing a mile, I am really frustrated as I get very painful achilles while running! The pain eases off completely after a while, but like many others, would be stiff first thing in the morning. I have played ladies football in the past 15+ years ago (I am 43 now) and this has always been a problem for me. I did manage a leg of a marathon 3 years ago but again achilles pain was a big problem. Any advice where my first port of call should be?

  17. Hi Jeff,

    I developed bilateral AT in Nov 2011. (Caused simply by too much forefoot landing and too much barefoot running on grass… classic mistakes.) Since then I have read hundreds of articles on the subject and seen several professionals. I want to let you (and everyone else reading) know that this is one of the best articles on the subject that I have come across. There are other good articles out there but this one hits on all the major points and does a good job.

    There are a few things that your article doesn’t mention, which maybe you can expand on:

    1) Should we ice after doing eccentrics? You mention to ice after running but not after eccentrics. Is this because running (and any other concentric-heavy training) is bad and should be iced to inhibit change in the tendon, while eccentrics are good and thus the body should not be hampered from “doing it’s thing”? Most PTs will tell you to ice after these exercises, but I wonder if icing would actually diminish the effect of the eccentrics.

    2) I realize that the jury is still out, but does it seem that by doing enough eccentrics one can fully “heal” themselves of this injury? Or will the tendon always remain in a “weakened” state no matter how much we do of the eccentrics?

    3) WARNING. I would like to caution everyone who is doing eccentrics. Don’t load up on weight too fast, make every change very small and do that weight for a week or more before adding weight. This also goes for the amount that your heel drops below the step. I had worked up to a lot of weight and decided one day that I should be dropping my heal a little lower, thinking it would be necessary for running up hills. There was no pain during the exercises that day but guess what happened the next day? I developed bilateral Plantar Fasciitis and still have it a year later. Just like AT, PF is no joke. PROGRESS SLOWLY and BE CAREFUL. These eccentrics are not idiot-proof. (As I have shown!)

    Thanks Jeff for your answers to my two questions.

  18. Great article thank you. I do not have any Achillies injuries but many around me do and these put them out of action for considerable lengths of time. As a preventitive measure should I routeninly incorporate some eccentric heel drop excercises and is it ok to use the dropped leg to lift my heel up after the drop?

  19. This was a very interesting and helpful article, as someone who’s been running for over 35 years (varying in intensity through the years). My achilles tendon issues (20 years or so?) ebb and flow, with an increase in problems happening with more mileage. I have tried lots-rest, ice, advil, massage, electric stim, night splints, accupuncture. I also went to a place that analyzed my running gait for feedback about tendencies that may affect my achilles. Honestly, I believe that some of us are just simply prone to this despite some earnest efforts to make change and treat it. I have come to accept that this is part of running for me though I try to be careful, stretch more, get new shoes more often and avoid certain types of running that add to the problem (sprints, e.g.). For me, I treat it as one might who has diabetes or some other chronic medical issue–just trying to manage it, or keep the major pain “at bay”. Anyway, I feel for all of us who have it, as running seems so easy without it!!

  20. I’ve never been much of a runner, but recently after completing the C25K for the 3rd time in about 5 years, I was challenged by twice in one day by two different people to forge ahead and set a new goal of running marathons. I’m registered for a 1/2 in November and started training and immediately started having serious calf pain. I have a history of serious plantar fascitis (saw podiatrist, had steroid shots, regular PT, wore boot, heel lifts, better footwear had eventual recovery) and thought it might be relapse related to that and going back to bad daily footwear habits. When I found your article I started connecting my history of PF together with current calf and AT pain and treatment. At first the pain seemed to be referred to the soleus but I was pretty sure it stemmed from midpoint AT. The treatment you recommend has been spot on and amazing–especially compared to recovery rate on earlier PF. I’ve followed your treatment diligently including icing after runs, heating the muscle before runs, diligent eccentric heel drops twice daily, rolling with The Stick, calf strengthening, sleeping with the support and general leg/hip/quad stretches. Over the last 6 weeks having just transitioned from C25K to 1/2 marathon training, the pain has subsided in the calf area but shifted into insertional AT. I’m wondering if I’m stripping away referre pain and getting to the real root of the problem–back to the PF cause which was always AT related. My questions:
    1) Any evidence to back up this assumed connection?
    2) I’ve been wearing low heel Merrells for walking one day a week. Should I ditch them and switch to my higher heeled running shoes for walking, too, for now?
    3) Should I also switch from eccentric to flat heel drops since pain has shifted?
    4) And, as someone asked earlier, should I ice following stretches or not? Thanks!

  21. I’ve been diagnosed with insertional Achiles tendonitis with significant calcification on the posterior exterior of the AT. Fortunately, based on an MRI, it appears that the calcification has been confined to the exterior of the AT, and there is tendon itself has only been compromised minimally. The condition has severely limited any running or tennis and has started to impact my ability to hike. Surgery was presented as the only viable course of action and has been scheduled for next week. First question: Even though the calcification is a result of the problem and not the problem itself, is removal warranted? Second question: Would I be correct in assuming that once the calcification has occurred, no amount of flat-ground eccentric heel drop exercises will remove the calcification? Thanks for an informative article and real world advice on this problem. Ken

  22. Hello, thanks for the informative article…I just started running about 2 weeks ago, nothing very intense (about 4-6 km at an easy pace), and I’ve noticed that my Achilles tendons can get pretty sore during the run. The pain is relieved almost immediately after I stop and it isn’t bothersome except when I run (mostly if there’s an incline). Should I be concerned, or is this just a part of the process of getting used to running again? I guess what I’m wondering is whether soreness in the area while running is a normal thing to experience, since the body is getting used to a new activity. Thanks in advance.

  23. I have dealt with insertional achilles tendonitis for >18 months. I think it was induced by taking Ciprofloxin for a sinusitis. It never really hurt while running but only afterwards and for days later. After 4 marathons and 2 IM triathlons, I was really wanting to fix it.

    So I booted it for > 1 month; then a PRP injection followed by 3 weeks casted; then another 3 weeks booted. How could this thing still be sore(even slightly) with those first steps when I’ve been sitting awhile. . . seems like nearly 3 months would be allow it to cool off completely.

    1. I’m cycling and swimming but not sure what to wait for prior to introducing running again. Should there be zero pain anytime?
    2. How much weight do I add for eccentric (flat surface) contractions? 30 lb dumbbell?
    3. Is the Cipro-induced tendonitis different? In that it takes time to recover and rest for exercise is irrelevant? (and that’s why mine is still slightly tender?)

    Thanks. I need to get back to overtraining. :-)

    • Hi ron

      I wondered how you were getting on now? After a short course of ciprofloxacin I have been having some At issues. Never in my life before taking the medical. I’m a 30 year old runner from uk. I’m just wondering when I’ll be able to run again. Switched ti swimming and cycling fir time being.

  24. I’m 63 now and haven’t run for 25 years. About 28 years ago while running and cycling, I got achilles tendonitis for a year. Stretching was in vogue at the time and still is to judge by some of the bunkum above. After a year I stopped stretching totally and had heavy massage and I’ve never had it back. I’ve cycled about 7000 miles a year since. There is NO scientific evidence of any benefit of stretching and in fact most runners here in Ireland no longer stretch. My daughter is an international runner and I’m a retired doctor and have extensively researched the literature on it. My daughter’s coach who was an Olympian himself often says.. “Did you ever see a racehorse stretch?”
    Stretching is hocus-pocus for runners.

  25. Any specific running shoes that anyone recommends for AT issues. I currently run in the ASICS Nimbus. Has a really cushioned heel which I feel may be adding to the problem. Not sure if there is a shoe guide out there for a shoe with a stiffer heel area.

  26. Achilles problems can be some of the hardest injuries to overcome when training for a marathon. I had server Achilles problems training for the Paris marathon this year. In fact it almost prevented me from running completely. I decided to create a blog to document my struggle and the tips I used to overcome the injury and still finish my goal of a sub 4 hour marathon. You can find my blog here: http://achillesmarathonrecovery.com/ I hope you it interesting and useful.

  27. These exercises are amazing. After the stretches with tightness and soreness gone I am thinking about resuming my running full force. Because I am running Boston in 2014, I am worried about conditioning etc. and right now I run 3X a week and then stretch like mad. These are helping tremendously. Funnily enough I had the same issue with tendon on the other leg last year and did these exercises and was able to qualify respectfully for Boston. Thanks and I am this exercise’s biggest fan.

    • Hi, just wanted to know how much you were running during the eccentric heel drop phase of your rehab. And was it slower that your usual training pace? Thanks for your time.

  28. After researching a lot of material, I initially thought that I might have IAT. But now, I’m unsure if it’s that or non-insertional AT. Because of that, rehabbing it is confusing for me. Does insertional AT have to be directly over the heel bone? Or can it be literally RIGHT above the heel none in that softer spot where the back of the ankle contours inward? I see to have a little tenderness directly on the heel bone, but I also can feel a little tenderness immediately above the bone. It seems like the location of irritation for me is almost right between where the two different types manifest. I’m really unsure. Can anyone give me some insight? Thanks!

  29. I have been suffering from midpoint tendinitis about 3 month with lots of advice from various physios. I tried the eccentric heel drops and the pain subsided within 2 day. I very pleased. however I do have a bump about 7cm’s from my heal. My question is; when do I use ice? I have being icing after heel drops.

  30. Going on one year for midpoint AT. Eccentric heavy load up to 40lbs X12weeks did the trick to get it feeling normal. Then I raced a 5k and did a few other fast runs over a week or so and it CAME BACK. It seems to be a little higher in the tendon now. No pinch tenderness any longer, just a dull ache. I am now slowly increasing mileage (at slower that usual pace) and restarting the drops. I do drops with weight and eccentric stretches after runs daily. I am having slow improvement. Thanks for your time.

  31. Cold Compression therapy really does the trick to keep inflammation down. There is a company that makes great wraps that target the Achilles Tendon that are comfortable practical to wear. I always wear them after a run whether I am hurting or not. This way it prevents the inflammation from building up. If you do consider these wraps, definitely look into purchasing the accessory strap as well. I have small ankles and need the additional cinching to make it a bit tighter. A lot of people do not consider cold as preventative action but it works well for me. Worth a look into at least for some.

  32. The standard Doctor’s direction for most Achilles Tendon injuries is to rest the injury and let it heal over time. Doctors usually recommend patients try to stay off their ankle as much as possible. To ease discomfort doctors often suggest taking something for the pain. With this course of treatment, in most cases, the Achilles Tendon will heal itself within 1 to 3 months. If you want superior treatment though, anyone can choose the same treatment used for Professional Athletes.

    With more severe or persistent Achilles Tendon injuries, or due to time constraints such as in the case of professional athletes, time is critical and a proactive treatment plan is required. For the most important patients, a regular routine of BFST (Blood Flow Stimulation Therapy) is typically undertaken to significantly accelerate healing. Where rapid recovery and complete healing of the Achilles Tendon are required, BFST is also required.

  33. Hello:
    Had plantar fasciitis since 2000. a year ago, I got some orthotics that seems to have eased the PF but the heel pain didn’t go away. a recent MRI then found insertional achilles tendinosis. not sure how long I have carried it. Ultrasound, myofascial release, exercise over the past two months have significantly eased the heel pain but…it’s not going away, even though I am not running. My physician is recommending PHP therapy. Should I be trying the eccentric exercises? any suggestions? thanks

  34. I was just wondering if doing eccentric heel drops on flat ground would have any good effect on midpoint tendonitis? I am aware the step variation is better for midpoint but i get better results doing the heel drops on the ground, if that makes any sense. Comments??

  35. Seeking advice. Have experienced what appears to be insertional Achilles tendinosis for 5+ years. Have run marathons every year until last year. Injury likely occurred when I changed training to include more speed work for Boston and also trained for Pikes Peak ascent (bad combo) in 2011. I quit running for 5 months this year and then did 4 weeks of eccentric drops. But I’m still getting pain on back of heel when I run. X-rays show what looks like bone spur or growth and I do have a visible bump at back of heel. Out of options I’m considering ESWT treatment. Will it be effective?

  36. I have unbearable pain if I take out my heel cups even for a couple hours. It has been a year and a half and nothing has changed. I don’t dare try anything here because I can’t even walk without a heel cup! (and by unbearable pain, I mean unbearable) Even not moving for a few hours I will feel throbbing pain on my achilles -out of options, any ideas for me? I’m about to move to Colorado where there will be all the mountain trails I’ve always wanted, and yet I think I will be tortured by the fact I can’t run on them instead while I’m there. I was considering getting Hoka One One Conquest shoes but honestly I feel doomed no matter what I do.

  37. I have IAT that is quite uncomfortable at the moment. Can’t run. Been running ~45 mpw with speed work, tempo runs, and a up tempo long run (Hanson’s plan).

    Would an elliptical be a reasonable cross training activity?


  38. Excellent article, thanks.

    Do you know if collagen supplements will help with achilles rehab?

    If heel drops cause new collagen fibers to grow, then perhaps an oral collagen supplement would accelerate the process a bit. Or perhaps not. I’ve searched around the web and can’t find any testimonies to this working. Cheers

  39. Question: Should both legs be exercised even if only one is injured? If so, should one use a box or step to get in the upward position on the injured side?

    I have mild discomfort near the insertion point following some aggressive hill work. Am trying to prevent it from becoming a larger issue using the suggested flat protocol.

    Thanks for all the great info you provide. You’re a great asset to the running/fitness community!

  40. I have had moderate IAT for the past 8 weeks which developed from cross-country skiing after a period of inactivity. I am seeing a physiotherapist, doing daily eccentric heel drops, etc. and I’m seeing a small amount of improvement, but progress seems to be slow.

    In the spring I usually add road cycling to my training regime, will cycling aggravate my IAT?

  41. I twisted my ankle really badly 3 years ago since then my form for walking and playing basketball suffered due to weakness in the foot. I continued playing and got really bad insertional achilles tendonopathy with a retrocalcaneal heel spur. It hurts like crazy after I run even a sort while. Swimming is probably the best exercise for my condition, I’ve given up hope and think this is a condition I will be suffering for the rest of my life. Surgery is really invasive and requires at least a year until you can be active again. I’m gonna see a podiatrist and a Chirac who specialize this type of injury.

  42. Hi,

    I got pain in my tendons from getting 2x500mg ciprofloxacin for 10 days.
    Does anyone know what to do?


  43. Dear all – a word of warning for any of you runners that also do explosive sports, eg squash or tennis. I have played the former to a high standard for 25yrs, had minor injuries but never an achilles issue. I also occasionally run. In April I developed what I now know was tendinitis from the running – ignored this for 2 weeks – played squash with a little discomfort then “BANG” = achilles rupture. So into the plaster,crutches, boot, physio routine. So, my message is, if you have these warning signs, you may get away with running, but lay off the explosive stuff. Cheers Richard

  44. Davis! Thanks buddy, cool to see u got all sorts if good info. I got a bump in my achillies this shit was helpful mang! Hope ur well!

  45. I have an achilies insert problem, had it for 7 weeks and no better, I have stopped running and last week only went swimming. I done squats the other day and now can feel it worse than before every so often when I walk. I read your site but confused on what to do as rest along is not working

  46. I’ve had insertional achilles tendonitis since last summer. I tried the eccentric heel drops which honestly didn’t seem to do a thing for me. I finally took 5 months off with no running and the heel was still irritated. What finally helped me was the combination of switching to a shoe with a higher drop (12 mm) and being dedicated with the contrasting bath each day. I’m back up to nearly 30 miles a week and while I occasionally have a bit of a stiff achilles in the morning it isn’t painful at all. I’m going to continue with the contrast bath the rest of the year to be sure but it looks like a good outcome.

  47. Thank you so much for writing this article! I developed an insertional tendinitis, I believe from switching shoes and wearing a pair that caused a lot of friction over the bursa.

    I find it very interesting that PT and Ortho MD recommendations vary quite a bit (Ortho recommends NSAIDS, stretching and rest while PT’s seem to recommend foam rolling over stretching, no NSAIDS, and light easy running). I always trust PTs with soft tissue injuries more so I am going to try this method and hopefully I’ll be back out on the roads soon!

    Love your site and I really value the information you give in these articles.

  48. has anyone tried a BFST device? by either mendmeshop or king brand?……does anyone recommend them……or not………why or why not?

  49. Please can anyone help with some advice. I have developed severe bilateral tendonitis after a course if ciprofloxacin. It keeps getting worse and now the pain is v bad at night from very minimal activity. Any kind of training is out and I am limited to hobbling around the home. I am six weeks out of the last antibiotic and getting really concerned. Because it is in both legs it makes things pretty impossible. Worse, no one really seems to understand the mechanism by which this damage occurred and so are wary of treatment plans. My pt told me rupture can, and does, occur with these cases and they want to be very conservative. I am not even sure if I can use heat as the pt thinks there is more inflammation with cipro damage than the usual mechanism.

    Also, I want to warn others to be extremely careful of these drugs.

    • Hi, I’ve had similar issues, only in the left heel, from doing physical activity while taking Levaquin. It’s been going on for five years. Doctors haven’t been much help. Someone clued me in to Hoka One One running shoes, which are about the softest shoes you can find, and even with them, I still add an orthotic on top of another orthotic, out of which I’ve cut the heel and replaced it with gel pads, which I change every month, believe it or not. I’m slowly working into these flat eccentric drops, but extremely slowly, and on both legs, not all weight on one. Reinjuring it is the worst thing you can do. Five years without being able to walk without a shoe, run, or jump. Where does yours hurt? Mine hurts right below the heel bone, where it meets the fatty part of the heel.

      • Hi John, thanks for sharing. Glad you have found some relief with the Hoka One shoes. It is good that you are taking the heel drops gradually, it is better to do them correctly, than to rush them and do them wrong. Hopefully you find some comfort from others within this forum!

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  51. I’ve had IAT now for 18 months. I had a boot on each foot for 3 months; now have pain in both heels all day. I started eccentric heel drops 4 weeks ago and the pain is continuing; sometimes it feels like it is getting a bit worse, though. I understand I will feel pain with eccentric heel drops; questions are how long before the pain should subside and how much pain is too much? I realize these are subjective questions; just looking for advice. Thanks.

  52. I had trouble all of last year with Plantar Fasciitis and some AT following an Ironman event. The Strassburg Sock is the best. You wear it at night to allow a slight stretch and to allow everything to heal. I am now at a point where I only wear the socks in the morning for 10 or 15 minutes–I make the stretch a bit more aggressive and legs feel great. Highly recommend the Strassburg socks.

  53. I am in week 5 of 12 with heel drops. I have noticed increased pain levels in the heels, but I understand that additional pain should be expected at first. Question is; how long before the pain stops if the therapy is working? Thanks.

  54. I’ve found that a very practical way to do heel drops is to go down stairs backwards. This avoids the little dance of switching to the other leg to go back up, and it’s especially helpful if like me you have both sides injured.

  55. Shockwaves helped me a lot – even though they only did the trick together with the exercises described in the article..
    I have been injured with AT some 40 years ago (I am 57 now), and never really cured since (got it all … from cortisone to plaster).
    I nevertheless had managed in the meantime to run 3 times a week for about 45′ – most of it uphill, fasted, at 5-6 AM – and after some years of that regimen, my achilles tendons were more than sore again.
    The only thing that worked to start with were shockwaves, but it all came back, when I tried to take up my regimen as before. What now really got me back to running was 1) a (new) series of shockwaves (while no running, some light biking hardly tolerated, followed by 2) eccentric exercises as described, together with: a special bandage with small rubber plots (achillotrain pro), hoka one one shoes (giving much more resistance than asics nimbus, but still with extreme cushioning), warming my tendons over night with hot packs, icing after running.
    I hope I will be able to get rid of these aids one day, but as of today, that’s what it took me to be able to run for about 1 hour, or something like 7 km … without major pain.
    Good look to all of you

  56. I have been struggling for the past 3 months. I made a brief comeback and was quite confident I was fully recovered. Had done 3 small runs through the week but on my 4th a felt my Achilles twinge again just below my calf. I have totally rested for the last 3 weeks and it feels good when walking round work or even when i try a little jog (approx 20/30 yards or so. But sometimes usually when I am sitting down I feel an odd twinge below the calf. I am scared to try anything in case it goes again but I really want to be back running again. Any advice would be really really appreciated. Thanks

  57. Ive been having jolts of pain every now and then at the bottom of my heel like a twissting and shocking pain. The pain is so bad that its bad enough to almost take me to the ground and i work in construction and want this to stop if there is anyone that can send me a link of some vids thatll be more specific on the exercises im nervous cuzz i torn my tendond on the side of my ankle and was out of work for 6 months and hearing something could go wrong with my achilies tendond scares me and i just turned 22

  58. If any of you guys are going through issues with achilles problems when training for a marathon then I feel your pain. I went through a terrible time when training for the paris marathon. You can read my tips and story here:


    My top tips are:

    1. Don’t get injured
    2. Don’t overdo it
    3. Invest in a pair of good trainers
    4. Stretch
    5. RICE
    6. Seek medical advice
    7. Stay positive
    8. Take some time off
    9. Come back slowly
    10. Stretch – I can’t stress how important this is!

  59. I am only 5 weeks post-op after sustaining a total rupture of my right achilles tendon, so I’m obviously not ready yet to begin these exercises. But have you any advise for how I can best prepare for eventually getting back out running? Time frames etc…the surgeon says I’m probably looking at 12 months untill active running? I was hoping to make it back sooner than that…any advice you can give me would be much appreciated.

  60. Hey guys, does anyone know what to do for mid-point achilles tendnitis *AND* insertional achilles tendonitis?? I have so far not seen anything on the internet for an injury like this!! It seems that I have pain both at the heel (or just above) and sometimes at the mid-point as well. The insertional pain is much more acute, and the mid-point pain more like a deep muscle type pain. At first I tried the eccentric heel drops off a step but after only slight improvement and realising I had insertional achilles tendonitis as well I stopped and started flat eccentric heel drops. Now the pain is much better overall but I still have mid-point pain when I run sometimes. Now I have no idea what to do. Should I do BOTH exercises? maybe on alternating days? Do eccentric heel drops off a step *cancel out* flat eccentric heel drops?

    Any help at all will be much appreciated. I have had this for about 5/6 months, and everytime I try to return to a run I get pain after around 1 mile. Cheers!

    • It would probably be safest to just stick with the insertional exercises, as you will still hit the muscles needed for the mid point. Sorry to hear you are having such a rough time, but hopefully the exercises start to strengthen that achilles in the right way, so it can calm down a little. Best of luck, let us know how you get on. We would be interested to hear!

      • Thanks for the speedy reply- much, much appreciated.

        I will ditch the eccentric heel drops off a step. I wonder if foam rolling the calf muscle instead would be a good way to combat the resulting stiffness without irritating the insertion point?

        Thanks again!

  61. For the past 3 years I have suffered daily with neuropathy. Well it’s been just 1 week and I just cannot put into words how brilliant my results have been. I have absolutely no more hyper sensitivity and no more agonizing burning pains.

  62. Hi guys,

    I’m running the London marathon in 10 weeks time, Its my first marathon, training is going well but as Iv’e increased the training im starting to feel a slight pain in my achilles tendon, I feel the pain for the first few miles then the pain goes away but feel it again the next morning, the pain isn’t too bad at the moment but can imagine its gonna get worse! I don’t really want to rest it for a few weeks as need to train, was wondering if you had any advise to get through it without resting? Thanks :)

  63. Hello, I have had what I guess would be midpoint achilles tendonosis for approximately 3 weeks. I have not run at all, since it seems to make it worse. However, I did not know what to do about it so I did nothing after the run. Can I run? If not, how do I know when I can start back up safely? How do I judge my progression? I currently have little to no pain while walking and most everything normal. I am trying to massage it rather than stretch it much. It is creaky. Thanks, Josh

    • Hi Josh, the suggestions we have made in this post are what we are able to offer for you. It would be impossible for us to make a specific suggestion for you as we do not know your body. Your best bet is probably to check with your physician, but make sure you incorporate the exercises we suggested into your daily routine at least twice a day right now. Massaging it is probably not a good idea as you may make it more irritated, but if you could get in to see a specialist, they may be able to help you get rid of some of the swelling. If it is creaking, it is probably going to need a little more time off. Make sure you add in the exercises for now! Hope this helps!

  64. Dear All,
    having been diagnosed with AT and plantar fasciitis since 200, I had given up hope. I was extremely fit working out 5 times per week. I piled on weight ie 100 pounds. I was always in constant daily pain.
    I am now pain free it is a miracle let me tell you how.
    I just happened to buy scholl tri comfort orthotics, which I used with memory foam cushion heel support. Voila the results are amazing. I am pain free and the bump on my heel is reducing.
    Please try it as I was having talks about surgery.
    Please note I am only using the orthotic and the heel supports in trainers only.
    Good luck

  65. I’ve got midpoint tendonitis in my right leg that I’m hoping to cure, but I was wondering if doing no calf exercises during the healing period is a good idea. If I do all the work to raise on my left leg, then won’t my calves become lopsided? Having one weaker calf seems like it would create a situation where I’m more likely to get injured. Should I do other exercises to maintain the calf muscle without damaging the tendon further?

    • Hi Paul, you would want to do exercises in both legs, as you can prevent it happening in the other leg also. You can still complete these during the healing phase, and some discomfort is okay, just make sure you are lifting up with both legs. Hope this helped!

  66. I’ve been running for 7 years, gradually building up speed and distance. Like off road/cross country and fell running. Did a off road race the weekend and damaged my achilles tendon, it’s difficult to walk on. swollen a few inches above the heal and feels a bit crunchy when walking. Would you recommend the eccentric heal drops right away?

    • Hi Karl, sorry to hear about your achilles, it would probably be best to give it a few days to calm down, but you can start them within a week, they can be a little painful as you lower down, but if it is extremely painful, back off and give it a few more days. Hope this helps!

  67. my right Achilles tendon hurts really bad and I don’t know if ive pulled it or tore it I cant bend my foot down or point my toes the only way I can bend my foot is upand even then It hurts but not as bad as it does when I try to bend it down

    • Hi Sean, sorry to hear about your achilles pain. Your best bet would be to go see your doctor, and they can diagnose you, once they give you this information, you can come back to this post and determine where you should start. Sorry this is not what you are looking for, but we cannot diagnose you unfortunately.

  68. i have had achilles tendinitis in both legs for months now. firstly, a huge thankyou for the modified exercises for those affected on both sides. secondly, my case is a little different as my doctors believe it was caused by a reaction to ciprofloxacin. as a result as well as the chronic bilateral tendinitis i am at increased risk of rupture. the problem is i cannot find a doctor/physio who understands cases caused by drug reactions or how to treat. it is so bad a potter around the supermarket leaves me in pain and it hurts a lot at night. does anyone know of a medical professional who knows how to treat this (neither anti inflammatories or steroids are an option as they can precipitate rupture). i am fairly desperrate at this point.

    • Hi Suzy, sorry to hear that. Hopefully someone will be able to help you out, but it may be difficult as our readers are from all over the world, and are not likely to be near you. Your best bet is to keep listening to your doctor, and hopefully it will improve.

    • Hi, I posted this reply to another similar post above. I’ve had similar issues, only in the left heel, from doing physical activity while taking Levaquin. It’s been going on for five years. Doctors haven’t been much help. Someone clued me in to Hoka One One running shoes, which are about the softest shoes you can find, and even with them, I still add an orthotic on top of another orthotic, out of which I’ve cut the heel and replaced it with gel pads, which I change every month, believe it or not. I’m slowly working into these flat eccentric drops, but extremely slowly, and on both legs, not all weight on one. Reinjuring it is the worst thing you can do. Five years without being able to walk without a shoe, run, or jump. Where does yours hurt? Mine hurts right below the heel bone, where it meets the fatty part of the heel.

  69. Many people describing Hakan Alfredson’s protocol mention performing the heel-drops and continuing through pain. I believe Alfedson himself said his patients would continue their heel-drops unless the pain became “disabling”, then once pain levels drop, add more weight.

    I’m curious about your description and definitions of this “pain”. What is a “good” pain vs “bad” pain. What type of pain should be expected as normal. For example, is a patient supposed to anticipate meeting the same pain that annoys them regularly during their tendonitis/tendonosis flare-ups, the midpoint tendon ache that occurs the morning after a “bad” run or run before fully recovered? Or is it a different type of pain akin to muscle-fatigue pain or stretching pain or something else?

    • Hi Greg, thanks for your question. When we talked about pain in this post, it was specifically during the motion of those exercises. It will probably be similar to those flare ups, but most people will not be running at the point where they are in pain for these exercises as they will be taking time off to recover. It will be a similar pain to that ache you feel during the flare ups. Hope this helps!

      • Curious, is email a requirement of successful therapy via this eccentric exercise? I slowly built up to 35 lbs (straight legged only) and never felt any ache or pain. Could that mean I wasn’t using enough weight?

        • oops – i meant “pain”, not “email”. Too much multi-tasking. Is inducing pain via the eccentric movement and critical component for success? thx!

        • When do you feel the tendon pain otherwise? If you never felt any pain, and you are sure you are doing the exercise correctly, then there may be something else going on.

          • I primarily only feel the pain during flare-ups which occur after some ‘disagreeable’ exercise. But i’ll rest for a week or two and after the flare-up the pain is mostly gone.

          • Hi Greg, it sounds like you understand your body pretty well by now. Just listen to the pain, and stay away from exercises that bring it on….and bring them back in slowly so you can test if it still bothers it. Best of luck!

  70. I have ruptured both of my Achilles tendons. The first one 35 years ago and the next 12 years later. I still run and compete in triathlon, having completed 2 Ironman and many ½ IM. I have been doing these exercises religiously for years. They work!

  71. So if you feel mild sporadic achilles pain coming on, you should start the eccentric heel drops right away, even though you have mild pain? Or should you wait awhile? Just want to make sure it’s OK to start doing the heel drops even though I have intermittent non-debilitating pain in the Achilles.

    • Hi Dave, it is probably safest to begin these exercises now, so that you can start building strength, and making sure the fibers are building in the right direction. Better to be safe than sorry :) Hope this helps!

      • Thank you Coach Tina. Your site’s article on AT is one of the most informative I have read on this topic. Great research combined with real world experience from runners in easily understandable language.

          • Thanks Tina. Follow up: the mild sporadic pain is on the right side of the Achilles, right foot, lower down adjacent to the bony prominence (end of fibula?) that juts out. Could this be a case of mild insertional AT? I’m not sure, but if it is, I guess straight leg flat ground heel drops are way to go? If so, am I damaging anything by doing flat ground heel drops if I have mid-point AT instead (and not insertional)? And I assume it’s still OK to run easy during this rehab protocol period if no pain.?

          • Hi Dave, thanks for going into a little more detail, helps us understand a bit better. I would say yes, use the flat heel drops, as they will not do you any harm even if it is mid point. If you have no pain, you are okay to run, run accordingly, but sounds like you are at a point where it is maybe in the healing phase, which makes these exercises especially important :) Let us know if we can help with anything else!

  72. Thanks again Tina! Much appreciate your help and the resources on this site..I’ll tell my running colleagues about it. I’ll also follow the recovery advisor feature on my Garmin 620 with HRM.

  73. Thanks for writing this article! It is quite helpful.

    I’ve been doing the heel-drops for over 6 weeks and I’m still experiencing some pain in my left achilles. They are tight/feel some pain in the morning when I do them. However at night, I don’t feel much pain at all besides the first set. I still haven’t added weight to the drops yet.

    With that being said, I can crack my left ankle and left big toe at will. Not sure if that is related or not. Should I be worried as a 23 year old? Would you recommend I see a specialist?

    • Hi Bruce, sorry to hear about your achilles pain. We suggest you should try using the weighted backpack for a while first, and then if it does not improve, then check with your physician. However, if you are concerned, it would definitely not be a bad idea to see a specialist. It is impossible for us to know if there is a connection between your ankle/toe and achilles pain. Hope this helps!

  74. Hi Coach Tina,
    One more question: should the (insertional eccentric) heel drops be done after runs so as to not overly stress the tendon (if so, about how long after)? I read that it might not be a good idea to heel drops before runs as this might overly stress the tendon (and I assume on non-running days it’s OK to do the heel drops at any time?). Thanks for any input you can provide!

    • Hi Dave, yes, probably best to do it after runs, although it does not really matter. Give it maybe an hour or so, but it shouldn’t make too much of a difference! Hope this helps!

  75. Hello,

    I was training for a 26+ mile hike/run race in August. I was already almost doing more than 20miles per week between running and going up down and stairs. No issues at all. I went to my first hiking/backpacking experience about a month ago. We walked with 30pund bags first day 9 miles, second day 12 miles. After that trip, the pain on my Achilles was really bad. I went to the Dr., who told me i have AT, wore a boot, and i just finished the physical therapy. They said, I can start training again, little by little. I know I will not be able to do all the 26+ race, I would like to still doing it until I am comfortable. I’ve been walking with regular shoes about 3 miles, no pain at all. But every time I wear my running shoes, the pain come back. I need some help from you guys with what brand or shoes i should get. I will really appreciated any help on this. Thank you so much!!!!

    • Hi Angelica, thanks for reaching out. Unfortunately we do not make specific recommendations on brands as we like to be neutral to all brands, but if you follow our recommendations in this post, you should find that the pain begins to subside, in addition to continuing your exercises that your PT gave you. Hope this helps, sorry we could not give you more specific advice!

  76. Thanks for this. Can now see where I’ve been going wrong. Once the initial pain has gone, I’ve been abandoning and trying to go full pelt. I shall now be regimental in the heel drops and warming, cooling and give it time. (Mind you, in a race, I’m still going to go for it, just can’t help myself,).

    • Hi Ivan, thanks for the comment, glad you enjoyed the article. Stick with those heel drops, and maybe stay away from races until you think it is healed enough to not aggravate it :)

  77. Thanks for the great article!

    Do you have any insight on the FHL muscle/tendon? I don’t feel pain when I do the heel drops and bent-knee drops. However, I do when I get on my toes or try to do any FHL stretch.

  78. Hey all,

    I want to share my battles with Achilles pain and how I’ve beaten it back with a committed, heavy-duty Stairmaster regimen. 

    I’m a 50 year-old male and have been an inconsistent runner and consistent soccer player for 30 years.  I have always had seriously tight calves and Achilles tendons.  Although I’m generally a fast runner, I’m not flexible at all.  I envy those folks that can squat flat-footed without their heels pulling up off the ground.  I’ve dealt with heel pain all my life and have had bone spurs removed from both heels in the past with surgery – along with the corresponding Achilles reattachment for that procedure. 

    About two years ago, I took up a regular running program and had some great success getting healthy, dropping a lot of weight, and eventually increasing my mileage to about 45 miles a week.  I had some improving half marathon times and was building for a marathon as I increased my mileage.  I also was playing soccer in an adult league.  I was feeling fit and healthy and confident and my foot problems seemed to finally be a thing of the past.  But then the hammer fell on me and chronic Achilles pain erupted in short order on my right foot.  For the next ten months I tried all sorts of programs to get back to running. I tried foam rolling, eccentric heel drops, stretching programs, and taking a month or two off.  Each time I tried to start with some modest running, my heel pain immediately flared back up.

    The pain for me was insertional, right above where the Achilles attaches to the heel.  I could press my thumb on the area and it would hurt.  When I ran, the pain would crop up with each step very quickly.  The worst part was that I was limping noticeably with simple walking each time I got up from a chair or out of my car.  If I ran even two or three miles at a slow pace, I would be limping the next day.

    As I hit Thanksgiving last fall I was limping around, had lost my fitness from the year before, and was carrying extra weight again.  I resigned myself to remedy this with surgery on my heel again after I had seen my doctor.  However, I have a quality Stairmaster that I’d bought on Craigslist about ten years ago.  The stairclimber has always been a go-to method for me to get a great cardio workout.  I have used this equipment off and on for spells at gyms and at home for many years, but mainly as an augmentation to running or soccer.  So, before I followed up on the referral my doctor had given to me for an orthopedic visit, I committed to working out an hour a day on my Stairmaster.  After about four or five weeks the results became noticeable that I was moving with a great deal less pain in my heel.  At about ten weeks, the pain had virtually gone away, my legs were stronger, and I was not limping at all.  My conditioning was back on track and I started playing full field soccer again with no heel pain.  That was a big deal for me!

    I’m now a little past four months on this 7-hour-a-week Stairmaster commitment.  It is a lot of hard work, but the results have really been well beyond my best expectations.  I know a stairclimber can be a grind at times like any cardio equipment, it can be BORING.  But, I setup my iPad and listen to music, read, watch Netflix, watch videos, etc.  Some days I’m motivated and some days it is a real grind.  If I cut a workout short one day then I make up the time the next day, so the numbers keep me motivated as well.  Importantly, I also wear a heart rate monitor and keep my pulse at a challenging target level – not usually over the top but consistent.  My fitness has been clearly improving as I’ve had to increase the levels on the machine to maintain the target heart rate zones.  I don’t use a StairMill, but a Freeclimber with independent foot pedals.  This allows me to vary the step range from short and rapid to longer up and down strides.  I also will work hands-free and not hold the rails to work on my balance and involve other leg muscles.  As I work out, I also will vary my foot positioning on the pedals, hang my heels off the back, or work out for a spell up on the balls of my feet.  I will keep things interesting by working in some tougher HIIT sessions once in a while.  At times, I’ll also work with some soft kettlebells for some light arm workout and this really pushes the hear rate up quickly. 

    I have been a lifelong Achilles heel sufferer.  This rigorous stairclimber regimen has made a great difference for me without surgery or physical therapy.  I believe the Stairmaster offers a focused strengthening of the muscles in the calves, and also duplicates some of the benefits of eccentric heel drop therapy. 

    The bottom line is that I feel great and can run without heel pain.  Separately, I’m in great cardio shape, my blood pressure is under control, and I am back playing soccer without feeling I had to give up the sport because of Achilles pain. 

    I hope this helps someone else as well.

    • Hi Kasey, thanks for sharing your story, and it is good to hear that you have found something that works for you. It is wonderful that you are able to play soccer again, and we hope you have continued joy in your sport. We have lots of posts for masters runners if you are interested in keeping up with the running. Just let us know if you need anything!

  79. Great exercises! Thank you. I have definitely been using some of these in my recovery. I’ve found that exercises along with the BFST Achilles wrap have greatly improved my condition. I truly believe in the body’s ability to heal itself and did not want to have to resort to surgery. After suffering with this condition for so many years, and missing so many marathons because of it, I was almost ready to consider it. But after I started on a routine of exercise and BFST I’ve noticed a huge change.

    • Bianca, I use the BFST wrap as well. I actually have links posted above to the products because I really believe in them as well. I have the achilles and the wrist wraps (pregnancy induced carpal tunnel…who knew!) and have recommended them to everyone! I agree. The body does have the ability to heal itself and it is best to avoid surgery.

  80. Hi

    Just wanted to say a big thank you for this post as it seems to have finally cured my problems. I tore a calf muscle 5 years ago and ever since have had AT problems. Despite huge amounts of rest and stretching of the problem calf it always came back. I’d nearly given up running distance altogether after the most recent occurance. I read your article and it made sense so I spent the last month resting and doing the exercises. I knew it was going to work for me when the day after I could barely walk due to the pain in my calf – it was clearly a part of the muscle that was very very weak in me. That was a month ago. I ran yesterday and for the first time in 5 years felt nothing in my achilles at all, nor this morning. I will continue the exercises as I slowly up my mileage and fingers crossed it continues like yesterday.

    For the record I also think foam rolling just before running really helps too.

    Anyway, thanks so much for your article and good luck to those other sufferers out there.


    • Thanks for sharing Niall, and that is why we do what we do! Thank you for letting us know, and best of luck with the rest of your running….hopefully no achilles issues in your future :)

      • Just wanted to add one thing (which hopefully can be confirmed by one of the coaches). As I posted in June this nailed a long running Achilles problem I had. In hindsight I believe it was all down to a weak Soleus muscle which is why the “The bent knee eccentric heel drop” exercise worked so well for me. I would just add that this exercise is worth doing with foot straight, slightly pointing inwards and slightly pointing outwards. My natural strike when running is foot pointing slightly outwards and I had a few problems with the soleus/achilles despite doing the exercise (only with foot straight). By changing the foot position and doing the exercises I found it strengthened all of the soleus that I needed to run pain free. Hope that might help anyone with similar problems.

        • Hi Niall, thanks for checking in. Yes, that would make sense, and we are happy to hear that you found this exercise worked for you, especially with the slight modification you mentioned. Thanks for sharing, and this may help other runners. We appreciate it! Best of luck with your training!

  81. hello,

    I have IAT in my left foot , it has been there for around 5 months.I used to play football a lot and also used to run a lot when I wasn’t playing football . I think that’s how I injured my foot.

    I have tried a lot of things to treat my foot. First I tried to heal it by taking only rest clearly that didn’t do any good. Then I went to a physiotherapist ,he advised me to treat it by putting the foot in a bucket of warm water with salt in it for 10-20 min daily . I did that for about 20-25 days but that also didn’t work. Then I went to a orthopaedic he advised me to take tendocare tablets,3 tablets per day for 20 days and also that warm water treatment but that also didn’t help. Can you tell me what is the use of these tablets as they are clearly not for treating IAT.

    Now for a month i have been taking complete rest , complete rest in the sense that previously i used to go for cycling almost every day, now I have stopped that also so that i don’t put any pressure on my foot.

    I want to ask you if cycling has any affect on the injured part ? can I do cycling without putting any pressure on my foot?

    In the beginning when I started experiencing pain ,it was during running but when i stopped running ,it pained only when it was pressed.I didn’t not have any pain while waking either.

    For a while i have been using the techniques that you have mentioned in this article and i think it’s working as i don’t have any pain in my foot anymore even on pressing the injured part .

    I didn’t feel any pain even when i started to do the heel drop exercise that you have mentioned , So does it mean that it is fine now or do i need to put more pressure on my foot during the exercise .

    I also wanted to know for whom this heel drop exercise is for, is it for the people who have problem even in walking due to IAT or for someone like me who has pain only while pressing the injured area.

    • Hello, thanks for reaching out and sharing your story. The detail you gave helps us to understand a little more. If you do not feel pain in your achilles while cycling, it has probably not been doing any damage or making it any worse. If you feel pain during or after, then it may have prolonged recovery. AS for the exercises, we are happy to hear that you are feeling better with the exercises, and it would be a good idea for you to continue them as prevention. These exercises are great for preventing achilles injuries, which you may be at risk of again in the future. You are probably okay to start back running, but after a lot of time off, we would recommend using the advice in this post http://runnersconnect.net/running-injury-prevention/returning-from-running-injury/ Hope this helps! Good luck!

  82. Increased my running to prepare for a Rugged Maniac…this included hill running. Yesterday I was going to do a light run. 2 minutes into the run it felt like a rock hit my achiles. Yesterday it was sore… I iced, wrapped and elevated throughout the day. Today there’s little soreness but still very tender. I will continue my icing and wrapping…but, is it possible to do Rugged Maniac in 6 days. I definitely have a minor tear and don’t want a full rupture. In a tough spot because the girl I like wants me to do race with her haha.

    • Hi Corey, thanks for reaching out. Sorry to hear about your achilles pain. It is impossible for us to tell you as we cannot see it, but if you do have a tear and you do decide to do it, you could be putting yourself out for a very long time. It would probably be better to race (and go support the girl anyway!!), and then you can race again shortly. otherwise you may be unable to run for a long time if you do any serious damage to your achilles. Follow the advice in this guide, and hopefully this helps! Ultimately it is your choice!

  83. Hello Tina & RC: I have periodic flare ups of what appears to be insertional AT, and feel a little coming on again now, not bad currently, about a 1 or even .5 out of 10 on pain/soreness scale. To confirm, I assume I should start (or continue, but this time add weight when they become easy) the flat ground eccentric exercises now, even with mild soreness? And should I stick to 3 x 15 twice daily (90 per day total), or will even more help (as some other places say)? Finally, I assume, per the Gotebord group study, it’s OK for me to continue to run as long as the pain/soreness stays below 5 out of 10? Thanks!

    • Hi Dave, Sorry to hear about your achilles pain. Yes, you are correct, that should all allow your AT to calm down enough to continue running, as long as you continue to listen to your body and what it is telling you. Hope this helps!

  84. Hi, After 10 yrs on and off with chronic tendinopathy, and various treatments, some worked for a while. I decided to see a Specialist who has researched and developed model and framework on this condition. The most up to date treatment for achilles chronic tendinopathy is tailored to the individual. Eccentric exercises are good but its a “one size fits all”. If u have a chronic condition eccentric may work for a time but eventually come back. Isometric exercises are a vital component in the treatment. Talking from experience. Most with a chronic condition are complex. Its all about the kenetic chain, not purely isolating the gastroc or soleus with treatment. Glutes come into it. Muscle imbalance and muscle atropy. Check out the work of Professor Jill Cook and Craig Purdam. Im writing this because i know hoele frustrating it can be to be doing what we think to be the right thing for our tendon but only eccentric exercises wont do the trick if you have a chronic condition. All the best.

  85. Very informative article. My question is about the timing of performing the heel drop exercises. I usually run in the evenings, does it make sense to do one set before and one set after the run? I don’t think I’d want to do these exercises first thing in the morning. Thanks for your help!


    • Hi Russell, thanks for reaching out. These may be a little more painful in the morning, but as we mentioned in the post, it is okay to have some pain. If your achilles is particularly sore right now, by all means start with them just in the evening, and then add in another time during the day also. Hope that helps!

  86. I injured my achilles in July 2014. After six months of pain I went to a local podiatrist who diagnosed me with insertional achilles tendonitis. He recommended the calf (achilles) stretching only. After three months of no progress doing these stretches I began researching online for other options. I read your article and immediately began the modified heel drops. I did them throughout the day and was still in intense pain most of the time and walked with a severe limp. I also did my regular morning exercises and continued very mild calf stretches when warming up, but did not “tug” as you say on my achilles. What you said made sense AND it has worked GREAT for me. Six months later I am back to full motion, no pain, and able to walk without the limp. I’m in my mid-sixties and don’t run much anymore but was really concerned that I may have had a life-long debilitating injury. I have added the modified heel drops to my regular exercises and continue to do them daily. Thank you so much for the in-depth article and giving me back my mobility. Best, zz

  87. Hi
    My doctor recently told me I had AT but he never specifically said which one. I am training for a marathon and I am 3 months into my training (the actual marathon is in march). I recently swapped from a normal Nike trainer to Nike Free Fly knit shoe.
    I didn’t gradually break them into my routine because my previous shoes had quite bad wet damage, and a week and a bit into running in them the back of my foot was hurting and looked swollen. To me pressure hurt it and also it looked as though a bone had swollen not a tendon because the swelling was hard. But the doctor told me to stop running and do calf raises. Resting calmed it down but I think this is only because I am not doing the exercise that was irritating it. I’ve changed my running form and quickened my cadence but some slight irritation is still there, threatening to come back.
    Does this sound like AT to you? I recognised a lot of what you were saying in the article and I really want to be able to finish this marathon! So I will start the exercises, what do you recommend I do about me shoes? I saw in the comments that the more people wore their minimalist shoes or barefoot the more it improved.

    • Hi Amy, sorry to hear about your pain. As you are still a good amount of time away from your marathon, it is important to get this taken care of now before you really get into the part where it could affect you (and put your training to a stop). The calf raises ill probably still help, but it would be impossible for us to diagnose what is going on, however, if you try the recommendations in this post, and notice it starts to feel better, then you are doing the right things. Otherwise it would be best to follow what your doctor is saying. As for shoes, you may have to try around with a few different types, to see which ones help to ease the irritation, sometimes runners find those minimal shoes actually make it worse as they have a lower heel to toe drop which makes the achilles work harder. Is there a reason you are in those flyknit? They may be a little too light for your every day training, it would be best to go to a running store and try a few pairs of running shoes on to see which ones feel most comfortable to you. Hope this helps! Sorry we cannot be more specific! Let us know if we can do anything else!

  88. Hi,

    I am a 62 year old female and have had Insertional AT in both heels for two years. I then formed bone spurs on the back of my left heal. Was then dignosed with Haglunds Syndrome and told by Orthopedic surgeon that I needed surgery to shave the bone spurs and lengthen the tendon. I had continued to play tennis 5 to 6 days a week throughout the 2 years but once the Haglund’s was involved the pain escalated after play to the point that I could barely walk for a week or so after. I have stopped playing completely for almost 4 weeks now, and have been doing the IAT exercises along with the encumbant bike ( which does not exasperate the archillies because of foot position ). My husband is a massage therapist and has been doing deep massage on my calves, heels and under foot. I also use ice and heat on and off and roll my calves. Things have been improving slowly but still have soreness and stiffness in my left heel. I have read in blogs that some people have had good results by aggressively massaging their heels with vaseline nightly. I notice in a couple of replies here that massage was not recommended as it is thought to agrivate the situation. Now I am wondering if I should stop massage and just continue with exercises. Would love any thoughts regarding this. Also want to say thank you to everyone involved in these posts. It is so helpful to realize that I am not alone with this persistent and frustrating injury.

    • Hi Heather, sorry to hear about your AT, glad it is slowly getting better. The massaging technique is risky, especially for those who are not certified. We try to base our posts off the science and the evidence backed research studies. We would recommend you follow the treatment plan we have in this post, and see how you get on. Glad the discussion was able to help you, and hopefully provide you some comfort too! We know how frustrating this injury can be!

  89. This is a great summary of the problem with tendonitis and it offers the right exercises to come back from this injury. I have had this for about 7 months and it was really depressing. During this time I wasn’t able to run and the pain got stronger or weaker without cause. Sometimes the achilles seemed almost ok and no pain occured. But then all of a sudden it hit back. So and forth I struggled with this ugly injury losing hope. The exercises presented here really helped me and after about 2 months of exercising, the pain left and the achilles seemed to get normal. Thanks for this valuable information. And keep patience guys ! It really heals very long !

    • Hi Paul, thank you so much for the kind words. We really appreciate you letting us know how much it helped, that is exactly why we put so much time and energy into articles like this. If there is anything else we can help with in the future, please let us know! Now go enjoy your training….pain free of course :)

  90. Hello Coaches,

    I’m hoping you can help me?

    I’m a 28 yr old female who has been lucky enough to have developed tendonitis in various places of my body over the past 2 years. I definitely overused my arms, but for all the other areas I have no clue. Almost a year ago I developed what my doctor told me was achilles tendonitis (symptoms were worst standing on my toes and/or stairs) in my left leg (not which kind of AT though, I had no idea about that until my own research many months later). Doc sent me to a PT who told me she thought I had plantar facisits instead, but “the treatment is the same, so it doesn’t really matter”. About a week into PT (a month after AT started in my left), I developed AT in my right as well. And surprise surprise I spent the next 1/2 year doing one ankle mobility exercise, rolling my foot out and stretching as prescribed (2 different stretches, 4 reps, 4x a day!) which seemed to help at first. Basically, I went from being able to stand for 5 minutes at a time without “get me to a chair symptoms”, to about 30 min or an hour. Oddly, once I stopped the crazy amounts of stretching my tendons started feeling better again. Not so sore and achey! I also started to suspect whether I had both types of AT and if that’s even possible? Pain at the bottom of my heels at insertion and at midpoint…

    My question involves not knowing how to proceed given certain painful symptoms. When this all started I had stabbing heel pain randomly while I was walking and always going upstairs, but then it became super sore tender spot on my midpoints. 6 months into this I started the insertional heel drops veery gradually until I was doing them twice a day, the recommended reps, they started feeling more tolerable to stand on or walk for longer periods at a time (about 2 months of this). By the end of this period my left glute became so unbearable tight I had to stop. I rested for a couple weeks before trying again and this time I modified how I did it and started stepping backwards down the steps (less glute having to pull myself back up the stair because it’s bilateral AT). I also started the midpoint kind because I really don’t know if I actually have both types and thought I’d give it a shot. I started very gradually again and not using full weight at first. The midpoint calf drops made my calfs and then my shins so sore, but I loved it! The soreness subsided and I had very little symptoms during and after the exercises (So excited!) until about a week into them. BAM! I started getting the super sharp pain in my heel like at the beginning of the year. Just the left side, the right side was fine and it occurred during the first 3 drops of the entire exercise and then for the rest of the day I would intermittently get the sharp heel pain going up stairs. The pain is directly on the inside of my heel near the bottom and sometimes on the outside of my heel. What could this be?

    Thoughts, suggestions, advice? After 3 days of trying to calf drop anyway, I stopped the exercises and the sharp pain no longer intermittently accompanies me up stairs or randomly while stepping on flat ground…On the last day of trying I did the exercises once in the morning and it reproduced the sharp pain. I didn’t do the night time exercise and the next day I didn’t have sharp heel pain. Been resting the past 5 days. Then, I stood on my toes for about 5 seconds yesterday and oddly enough the sharp pain came back for the rest of the day whenever I went upstairs. What is going on? Also, my left glute is still insanely tight. Correlation?

    • Hi AJ, it is definitely possible to have AT in both areas, it sounds like you definitely have AT, and the stretching you talked about was making it worse. We would recommend using our guide to rehab you back to strength, it is unlikely that it will go away on its own. If not, it would probably be safest to go see a physician to see if something else is going on. It could be related somehow, we do have an article on how your hips can cause injuries, hopefully this helps http://runnersconnect.net/running-injury-prevention/the-relationship-between-hip-strength-and-running-injuries-the-latest-research/ If we can do anything else to help, let us know! Best of luck with your recovery!

      • Coach Tina,

        Thank you so much for responding. I read the link on hip strength. I am more than willing to strengthen my hips, but earlier this year I was doing the bridges mentioned in the link you sent, in addition to physical therapist prescribed chair squats and a couple of other exercises for the supposed patellar tendonitis I developed several weeks after the achilles tendonisitis. The pateller tedonitis went away (yay!), not the AT and now I have an EXtremely tight left glute. It’s actually the reason I stopped the bridge exercises and then all the others.

        I’ve seen so many other physicians to find something systemic that may be wrong and have arrived at nothing. Still trying though.

        Would strengthening my hips possibly give relief to my tight left glute? Or would it cramp up more? Maybe my hips are the underlying cause of the patellar tenonidit and the achilles?

        • Hi AJ, sorry to hear that the physicians have been less than helpful. I would recommend listening to this podcast episode with brad Beer, he talks about the frustration of not finding a specialist who can help, but everyone CAN run pain free, you just need to find the right person. It might provide you with some comfort. Here is the link http://runnersconnect.net/rc80 Strengthening your hips would almost definitely help, weak hips are the cause of many runner issues, and it would make sense that they are the source of your problems. Worth a try right? Good luck!

  91. Hi Guys, I’ve had big problems with both achilles for a number of months now (mid-point). Both chronically inflamed, I just could not seem to get them better. After a visit to a specialist I ended up completing a course of ACP (autologous conditioned plasma) injections. This has successfully removed the constant pain which is great and I have now begun the 12-week stretching and strengthening program. I have now completed 1 week so early days.

    Your article mentions the possibility of pain during the exercises; can I assume you refer to mid-point achilles pain in my case? I get sore calf muscles during the stretching but no pain in the achilles itself. I am however noticing slight pain in both achilles first thing in the morning, which disappears once I am warmed up. This is how my chronic inflammation started so I am naturally worried that things are not off to a good start. Any thoughts? Does the absence of achilles pain during the exercises mean I should add some weight already?

    Also, I have limited ankle flexibility in my right foot which is hindering me from getting a good stretch in. I can only go very slightly below horizontal before I get pain and restriction in the ankle joint and surrounding ligaments. Will this range of movement be sufficient to address the achilles? Any other suggestions here?

    Many thanks for your response!

    • Hi Ritche, thanks for reaching out. Sorry to hear about your problems with AT. What you are describing sounds pretty typical of AT, both insertional and midpoint. It would be a good idea to add the weight if the drops feel okay without it right away. It might be a good idea to try to see a chiropractor or specialist to see if there is some kind of tightness elsewhere that could be causing your problems. Hope this helps, and the recommendations in this post should help the symptoms continue to decrease!

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