Author: DokterSingapura Editorial Team
Clinical review: Dr Terence Tan, licensed medical doctor in Singapore
Founder, The Pain Relief Clinic
Reviewed: May 2026

Achilles tendon pain can be frustrating because it often appears gradually.

At first, it may feel like a mild tightness behind the ankle.

Then it becomes more noticeable when:

• walking quickly
• climbing stairs
• running
• jumping
• standing on tiptoe
• wearing certain shoes
• starting exercise after rest
• walking uphill

Some people feel pain higher up along the tendon.

Others feel pain closer to the back of the heel.

The practical question is:

Is this Achilles tendinopathy, a tear, shoe irritation, or something else?

What Is The Achilles Tendon?

The Achilles tendon is the strong tendon connecting the calf muscles to the heel bone.

It helps with:

• walking
• running
• jumping
• climbing stairs
• pushing off the foot
• standing on tiptoe

Because it handles high loads repeatedly, it can become painful when load exceeds tissue tolerance.

What Achilles Tendinopathy Feels Like

Achilles tendinopathy usually refers to pain and dysfunction involving the Achilles tendon.

Common symptoms include:

• pain along the tendon
• stiffness in the morning
• pain at the back of the heel
• pain that worsens with activity
• tenderness when squeezing the tendon
• swelling or thickening
• pain after running or walking
• stiffness after rest

AAOS describes Achilles tendinitis symptoms as including morning pain and stiffness along the Achilles tendon, pain along the tendon or back of the heel that worsens with activity, thickening, and swelling. (OrthoInfo)

Midportion vs Insertional Achilles Pain

Achilles pain is often divided into two broad patterns.

Midportion Achilles Tendinopathy

This usually causes pain a few centimetres above the heel bone.

It may feel like:

• tendon stiffness
• pain when running
• pain during calf raises
• thickening along the tendon
• soreness after exercise

Insertional Achilles Tendinopathy

This causes pain where the tendon attaches to the heel bone.

It may be aggravated by:

• uphill walking
• shoes pressing on the back of the heel
• deep calf stretching
• stairs
• running

The distinction matters because treatment loading and stretching strategies may differ.

Why Achilles Pain Often Feels Worse In The Morning

Many people describe stiffness during the first few steps after waking.

This happens because the tendon has been relatively unloaded overnight.

When you stand and walk, the tendon suddenly has to tolerate load again.

Morning stiffness can be a useful clue, especially when combined with pain during walking, running, or tiptoe movement.

Why Rest Alone Often Does Not Solve It

Many patients stop running or exercising for a while.

The pain improves.

Then it returns once activity resumes.

This is common because rest may calm symptoms temporarily, but it does not necessarily improve the tendon’s ability to tolerate load.

NHS Inform notes that Achilles tendinopathy can take several months or more to manage and that it does not improve with rest alone; activity often needs to be modified rather than stopped completely. (NHS inform)

This is why a graded loading plan is often important.

Why Load Management Matters

Achilles tendon pain often appears after a change in load.

Examples include:

• starting running again after a break
• increasing distance too quickly
• adding hill running
• playing more sport than usual
• changing shoes
• walking much more during travel
• switching to flatter shoes
• doing many calf raises suddenly
• returning to exercise after illness

The tendon may not be ready for the sudden increase.

According to Dr Terence Tan, Achilles pain often becomes persistent when patients only rest during flare-ups but never rebuild the tendon’s load tolerance in a structured way.

Achilles Tendinopathy vs Achilles Tear

This distinction is important.

Achilles tendinopathy usually develops gradually.

An Achilles rupture is more sudden and more serious.

Possible rupture symptoms include:

• sudden sharp pain at the back of the ankle
• feeling like being kicked in the calf
• a pop sensation
• difficulty walking
• difficulty pushing off
• inability to stand on tiptoe
• visible gap or weakness

AAOS notes that Achilles tendon tears often occur from injury and that a large or full tear can be disabling, although treatment may be surgical or non-surgical depending on the case. (OrthoInfo)

A suspected rupture should be assessed promptly.

Other Causes Of Back-Of-Heel Pain

Not every pain near the Achilles is tendinopathy.

Other possibilities include:

• retrocalcaneal bursitis
• Haglund-type heel irritation
• shoe pressure
• calf strain
• ankle joint irritation
• referred pain from the back
• inflammatory tendon pain
• stress injury in selected cases

Persistent or atypical symptoms should be evaluated rather than assumed.

Does Achilles Pain Need Imaging?

Not always.

Many cases are diagnosed clinically based on:

• location of pain
• tenderness
• activity pattern
• morning stiffness
• calf raise tolerance
• tendon thickening
• training history

Imaging may be considered if:

• rupture is suspected
• symptoms are severe
• diagnosis is unclear
• pain persists despite care
• swelling is unusual
• there is concern about another cause
• treatment decisions depend on structural clarification

Ultrasound or MRI may be used depending on the question.

What Conservative Care May Include

Conservative management may include:

• activity modification
• temporary reduction of running or jumping
• avoiding sudden hill work
• supportive footwear
• heel lifts in selected cases
• progressive calf strengthening
• tendon loading exercises
• physiotherapy
• gradual return to sport
• review if symptoms do not improve

The 2024 clinical practice guideline for midportion Achilles tendinopathy supports tendon loading exercise as a key first-line treatment to improve function and reduce pain when tendon structure is not considered fragile. (APTA Orthopedics)

Why Stretching Needs Care

Stretching may help some people, especially with calf tightness.

But stretching is not always the best first move for every Achilles problem.

In insertional Achilles pain, deep dorsiflexion stretching may aggravate symptoms because it compresses the tendon near the heel bone.

This is why the location of pain matters.

A plan should be matched to the type of Achilles pain.

Common Patient Mistakes

Mistake 1: Complete Rest Only

Rest may reduce pain temporarily but may not rebuild tendon capacity.

Mistake 2: Returning To Running Too Quickly

Symptoms may flare if loading increases faster than the tendon can tolerate.

Mistake 3: Ignoring Morning Stiffness

Morning stiffness can indicate the tendon is still irritable.

Mistake 4: Stretching Aggressively

Deep stretching may worsen some insertional Achilles pain patterns.

Mistake 5: Missing A Rupture

Sudden pop, major weakness, or inability to push off should be assessed promptly.

When To Seek Assessment

Consider assessment if:

• pain persists for several weeks
• walking or stairs are affected
• the tendon is swollen or thickened
• pain worsens despite rest
• running repeatedly triggers symptoms
• morning stiffness persists
• pain is close to the heel insertion
• diagnosis is unclear

Seek prompt review if:

• pain started suddenly with a pop
• you felt like something hit the calf
• you cannot push off the foot
• you cannot stand on tiptoe
• there is major weakness
• walking is difficult after injury

These may suggest more than routine tendinopathy.

Practical Questions To Ask Yourself

If you have Achilles pain, ask:

• Is the pain higher up the tendon or at the heel insertion?
• Is there morning stiffness?
• Did I recently increase walking or running?
• Did I change shoes?
• Does pain worsen during or after activity?
• Can I stand on tiptoe?
• Was there a sudden pop or injury?
• Is swelling or thickening present?
• Is the pain improving, stable, or worsening?

These answers help decide whether conservative care, physiotherapy, imaging, or medical review is appropriate.

The Main Takeaway

Achilles tendon pain is often related to load tolerance.

Rest alone may calm symptoms temporarily, but persistent Achilles pain usually needs a structured approach that manages load and gradually rebuilds tendon capacity.

Pain location matters.

Midportion Achilles pain and insertional Achilles pain may need different strategies.

Sudden pain with weakness, a pop sensation, or inability to push off should be assessed promptly because it may indicate rupture.

The goal is not simply to stop pain for a few days.

The goal is to restore safe walking, stair use, exercise, and tendon capacity over time.

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FAQ

Why does my Achilles hurt in the morning?

Morning stiffness is common in Achilles tendinopathy because the tendon is suddenly loaded again after hours of rest.

Is Achilles tendinopathy the same as a tear?

No. Tendinopathy usually develops gradually, while a tear or rupture is often sudden and may cause major weakness or difficulty pushing off.

Should I stop running completely?

You may need to reduce or modify running temporarily, but complete rest alone often does not rebuild tendon capacity.

Do I need MRI for Achilles pain?

Not always. Many cases are diagnosed clinically. Ultrasound or MRI may be considered if rupture is suspected, diagnosis is unclear, or symptoms persist despite appropriate care.

When should Achilles pain be checked urgently?

Seek prompt assessment if pain began suddenly with a pop, you cannot stand on tiptoe, you cannot push off, walking is difficult after injury, or major weakness is present.

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About The Medical Reviewer

Dr Terence Tan is a licensed medical doctor in Singapore and founder of The Pain Relief Clinic. He has over 20 years of clinical experience in musculoskeletal assessment and practical non-surgical care pathways.

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Medical Disclaimer

This article is for general educational purposes only and does not replace personalised medical assessment, diagnosis, or treatment by a licensed healthcare professional.