Medically reviewed by Dr James Bristol, MD, PhD · Updated 2026-11-14
Achilles tendonitis (Achilles tendinopathy) is best treated with a structured loading programme, such as heel-drop exercises, for at least 12 weeks. The classic Alfredson eccentric programme (1998) became a standard because most patients returned to activity. Shockwave can add benefit. A well-known trial in JAMA (de Vos, 2010) found PRP was no better than saline when added to exercise for chronic mid-portion Achilles tendinopathy.
Symptoms
- Pain and stiffness at the back of the heel, worse in the morning
- Pain at the start of activity that may ease, then return after
- A thickened, tender tendon
Tendon pain for more than 3 months? Get the free guide and a doctor review of your scan.
Treatment
- Loading exercises daily for 12 weeks
- Reduce, do not stop, aggravating activity
- Heel lifts in shoes short term
- Shockwave therapy if progress stalls
- Injections: avoid cortisone into the Achilles (rupture risk); PRP or stem cells for persistent cases, with realistic expectations
Sudden snap?
A pop and inability to push off suggests a rupture: see a doctor the same day. See when surgery is needed.