Achilles Tendonitis: Causes, Symptoms and Treatment Options: Physiotherapy & Hyaluronic Acid Injections Iron Acton & Yate BS37
- Daniel Taylor
- May 27
- 5 min read
Updated: Jul 7
Achilles tendonitis is a very common condition that causes pain, stiffness, and irritation within the Achilles tendon — the large tendon that connects the calf muscles to the heel bone. It commonly affects runners, active individuals, and people who spend long periods on their feet, although it can occur in anyone.
What Are the Symptoms of Achilles Tendonitis?
The symptoms of Achilles tendonitis can vary from mild discomfort to significant pain that limits walking and exercise. Common symptoms include:
Pain or stiffness in the Achilles tendon, especially first thing in the morning
Pain that worsens after activity or exercise
Tenderness when touching the tendon
Swelling or thickening around the tendon
Difficulty walking, running, or climbing stairs
Many people notice the pain improves slightly as they “warm up,” before becoming worse again later in the day.
According to the NHS, Achilles tendon pain is commonly linked to overuse and repetitive strain injuries.
What Causes Achilles Tendonitis?
Achilles tendonitis is usually caused by repetitive strain and overload of the tendon over time. In many cases, there is not one single cause, but several contributing factors.
Common causes include:
Overuse or repetitive exercise
Sudden increases in activity levels
Changes in footwear
Tight calf muscles
Poor lower limb biomechanics
Aging and degeneration within the tendon
Research published within the British Journal of Sports Medicine has shown that tendon problems are often associated with repeated overload and failed tendon healing responses.
The condition is particularly common in runners and individuals who suddenly increase their walking, training, or gym activity.
Initial Treatment for Achilles Tendonitis
In the early stages, conservative treatment is often very effective. Initial management typically includes:
Rest and activity modification
Ice or heat therapy
Anti-inflammatory medication (where appropriate)
Gentle stretching exercises
Progressive strengthening exercises
Evidence suggests that eccentric strengthening exercises can be particularly effective in improving Achilles tendon pain and function. Studies published in the Journal of Orthopaedic & Sports Physical Therapy support progressive loading programmes as a key component of rehabilitation.
It is important to understand that Achilles tendon problems can take time to settle. In many cases, symptoms may take up to 12 weeks to fully improve.
For simple exercises you can find them on my you tube channel:
If symptoms persist, physiotherapy can help improve tendon strength and function. Treatment commonly includes:
Progressive rehabilitation exercises
Calf strengthening programmes
Hands-on soft tissue therapy
Acupuncture
Biomechanical assessment
Advice regarding footwear and activity modification
The National Institute for Health and Care Excellence (NICE) recommends exercise-based rehabilitation and conservative management as first-line treatment for many tendon-related conditions.
Although physiotherapy can be highly effective, recovery often requires consistency and multiple treatment sessions before significant improvements are seen.
We generally recoemned on at least 6 sessions of hands on physiotehrpay. During the session we use of fingers and thumbs to work into the Achilles tendon. This is a technique known as frictions. The treatment can be painful to have done but it helps break down the adhesions that exist between the tendon tissue and the sheath which helps reduce inflamation and achieve recovery.
Here at Elite Joint solutions we will commonly recommend dry needling for the treatment of Achilles Tendonitis. Dry needling helps break down the adhesions between the sheath and tendon and also generates a blood supply to help promote healing. It can also help break up the process of neovascularisation which is thought to be a leading cause of Achilles Tendonitis.
What Is Overpronation: The Importance of Foot Biomechanics
One factor that is often overlooked when treating Achilles tendonitis is the role of foot biomechanics.
In many cases, abnormal loading patterns through the foot can contribute to ongoing irritation of the Achilles tendon and may even be the reason why symptoms keep returning despite treatment.
A common biomechanical issue we see in clinic is overpronation. This occurs when the arch of the foot collapses excessively during walking or running. As the foot rolls inwards, the Achilles tendon is forced to twist and "kink" slightly during weight-bearing activities. Over time, this creates abnormal stress within the tendon fibres and can contribute to pain, inflammation, and degeneration.
Research has shown that altered foot biomechanics can increase loading through the Achilles tendon and may contribute to the development and persistence of Achilles tendinopathy. For this reason, assessing the foot and ankle should form part of any comprehensive Achilles tendon assessment.
Can Insoles Help Achilles Tendonitis?
The good news is that abnormal foot mechanics can often be improved using orthotic insoles.
By supporting the arch of the foot and reducing excessive pronation, insoles can help reduce abnormal loading through the Achilles tendon and improve the efficiency of walking and running mechanics.
In my clinical practice, I generally recommend one of two options:
Entry-Level Orthotic Insoles
For patients with mild to moderate overpronation, an off-the-shelf orthotic can often provide significant improvement.
A popular option is:
These can be an excellent starting point and are relatively inexpensive compared to custom solutions.
Premium Orthotic Insoles
For patients with more significant biomechanical abnormalities or long-standing symptoms, I often recommend:
These provide greater control of foot mechanics and are commonly used by healthcare professionals involved in musculoskeletal and sports injury management.
Fine-Tuning Orthotics with Posting
Whilst standard insoles are effective for many patients, some individuals require additional correction.
This can be achieved using rearfoot and forefoot posting wedges, which allow a clinician to make small adjustments to the way the foot loads during walking and running.
Examples include:
These additions can help optimise foot alignment and further reduce excessive strain through the Achilles tendon.
Why Professional Assessment Matters
I would always recommend having your feet assessed by a suitably qualified healthcare professional before purchasing orthotics.
Whilst orthotics can be extremely beneficial, prescribing the correct level of correction is important.
If the foot is over-corrected, it can simply transfer stress elsewhere in the body and potentially cause new symptoms. Conversely, if the foot is under-corrected, the insoles may fail to provide their maximum benefit.
A professional biomechanical assessment can identify:
Excessive pronation
Leg length discrepancies
Forefoot and rearfoot alignment issues
Gait abnormalities
Running mechanics
The most appropriate orthotic prescription for your needs
At Elite Joint Solutions, we offer an alternative treatment option using hyaluronic acid injections for Achilles tendonitis.
Hyaluronic acid is a naturally occurring substance found within the body. When injected around the Achilles tendon, it helps improve the smooth gliding movement of the tendon fibres while reducing irritation, inflammation, and pain.
We use Ostenil, which also contains mannitol — a natural substance that helps reduce inflammation and protect the tendon from further irritation.
Potential benefits of hyaluronic acid injections include:
Reduced pain and inflammation
Improved tendon movement
Faster return to activity
Minimal downtime
Low risk of side effects
Emerging evidence within sports medicine literature suggests hyaluronic acid injections may help improve tendon healing and reduce pain in some chronic tendon conditions.
Unlike steroid injections, hyaluronic acid injections do not weaken the tendon and carry no known risk of Achilles tendon rupture.
When Should You Seek Treatment?
You should consider seeking professional assessment if:
Symptoms persist for more than a few weeks
Pain is affecting walking or exercise
The tendon becomes swollen or thickened
You are unable to return to normal activities
Conservative treatment is not helping
Early treatment can help prevent long-term tendon degeneration and improve recovery times.
Book an Assessment
If you are struggling with Achilles tendon pain and would like to discuss treatment options, visit:
Elite Joint Solutions Booking Page https://www.elitejointsolutions.com/contact-us
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