Written by Zita Sham, Fairuuz Saleh and Shiv Mohan Banka, Principal Physiotherapists at Phoenix Rehab.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 4 October 2026.
Achilles tendinitis is an overloaded Achilles tendon: pain and stiffness at the back of the heel or just above it, worst first thing in the morning and at the start of a run. Rest makes it feel better. It rarely makes it better, which is why it comes back the week you return to running. What changes the tendon is load, built up in steps. Most people need about 12 weeks of loading work, and some need six months or more.
Key takeaways
- Achilles tendinitis is an overloaded tendon: pain and stiffness at the back of the heel or just above it, worst first thing in the morning and at the start of a run.
- Rest settles the pain. Load, built up in steps, is what changes the tendon. Most people need about 12 weeks of loading work, and some need six months or more.
- Mid-portion pain sits roughly 2 to 6 cm above the heel. Insertional pain sits where the tendon meets the heel bone, and its heel drops stop at floor level.
- Running is often fine if pain during the run stays at 5 out of 10 or below and has settled by the next morning.
- A sudden pop or kick at the back of the ankle, then being unable to rise onto the toes of that leg alone, means the emergency department now.
Which kind is yours?
Where it hurts changes the plan.
| Mid-portion | Insertional | |
|---|---|---|
| Where it hurts | In the tendon itself, roughly 2 to 6 cm above the heel, often with a thickened, tender lump | Right where the tendon meets the heel bone, at the back of the heel |
| Who gets it | Runners, HYROX and court athletes, people who stepped up their training | Older runners, people on their feet all day, people with a bony bump at the back of the heel |
| What it hates | Hills, speed work, the first run after a few days off | Shoes rubbing the back of the heel, uphill walking, stretching the calf hard over a step |
| How the loading differs | Heel drops can go below the level of the step1 | Heel drops stop at floor level, because dropping lower squeezes the painful spot2 |
Pain behind the heel that is not in the tendon at all, or pain under the heel, is a different problem. See heel pain.
Can I keep walking and running?
Walking, yes. Running, often yes, if you follow a simple rule: pain during the run stays at 5 out of 10 or below, and any pain after it has settled by the next morning, and is no worse week to week. In a randomized trial, people who kept running under that kind of pain rule did as well as people who stopped.3 If the next morning is worse, the load was too much: drop the distance or the speed, not the whole plan.
How long does Achilles tendinitis take to heal?
| Weeks | What usually happens |
|---|---|
| 0 to 2 | Settle the irritation: less hill and speed work, a short-term heel lift if it helps, loading started inside your pain. |
| 2 to 6 | Heavy, slow calf work most days. The morning stiffness shortens. This is where most people feel better and stop. |
| 6 to 12 | Strength built at long length, then springier work: skipping, hopping, then running speed and hills back in steps. |
| 3 to 6 months | Longstanding cases, and insertional pain, often take longer. The loading is the same idea, adjusted.2,4 |
These are typical ranges. The measures decide each step, not the calendar.
Achilles tendinitis treatment in Singapore: who does what
- A doctor (your GP, a sports doctor or an orthopedic surgeon) diagnoses it, decides whether you need a scan, and decides about medication or injections.
- A physiotherapist runs the loading program, adjusts your running, and measures your progress.
- Shockwave therapy is sometimes added for longstanding cases, alongside the loading, not instead of it.
- Surgery is uncommon and is a surgeon’s decision, usually only after six months of well-run loading has not helped.
At Phoenix, every appointment is one to one with the same physiotherapist for 45 minutes.
What we measure
- Single-leg heel raises. How many you can do on the sore side against the other side, and how high you rise. The sore side is often weaker than people expect.
- Hopping. Single-leg hops, counted and timed, before running speed comes back.
- Morning stiffness. How many minutes it lasts, week to week.
- A questionnaire (VISA-A) that scores pain and function, so progress is a number, not a feeling.
Tested, not dated. Hills and speed come back when the measures say so.
What you can do at home this week
- Keep moving. The tendon adapts to load, not to rest.
- Swap hills and speed work for flat, easy running inside the pain rule above, or cycle for two weeks.
- Do slow heel raises on both legs, then on the sore leg, every day. For insertional pain, do them on flat ground, not off a step.
- Avoid shoes that press on the back of the heel. A small heel lift can ease insertional pain in the short term.
- Don’t stretch the calf hard over a step if the pain is at the heel bone.
When to see a doctor first
- Go to the emergency department now if you felt a sudden pop or a kick at the back of the ankle and now cannot rise onto the toes of that leg alone, even if you can still walk. The tendon may have torn. See Achilles tendon rupture. Also go now if the back of the heel is hot, red and swollen and you have a fever.
- See a doctor the same day if the calf is swollen, hot and painful. If you are also short of breath or have chest pain, call 995.
- See a doctor the same day if Achilles pain started during or in the months after a course of antibiotics. Tell them which one.
- See a doctor soon if both Achilles are painful with no change in your training, or if other joints are swollen too.
Dancers can find every dance injury, by body part, on dance injuries.
The HYROX sled push, and the run straight after it, load the Achilles back to back. See HYROX injuries, station by station.
Where are you with this right now?
1. It is settling on its own
Foot and ankle problems are slow but usually very treatable. Months rather than weeks is normal, and improvement is judged over a month, not a day. If the first steps in the morning are easier than they were four weeks ago, you are on the right road. You do not need us for this, and we would rather say so.
2. It has stopped improving
The first ten steps out of bed are still the worst part of the day. You choose shoes by how long you will be standing. You still look at the ground when you walk.
Symptoms settle well before the tissue has rebuilt its capacity, which is why stopping the loading work early is the most common reason this drags on for years. That is the gap worth measuring, and it is not measured by how you feel on the day.
The Stalled Recovery Review is three appointments over three weeks with the same therapist, because what a joint does under load cannot be read in one visit. The first finds what is limiting it. The next two measure how it responds. $690, nett, no GST, which is three appointments at $230.
3. You have had surgery, or you have a date
Recovery after an operation has a shape, and knowing which stage you are in tells you whether you are on it. See the recovery programs, or ankle physiotherapy if you are not sure which applies to you.
All of it runs on the same four stages. The Phoenix Recovery Protocol explains what each stage works on and what you have to meet to move up. No referral needed to start.
Next step
Find out which stage you are in
Pain is the first thing to leave. Movement and strength are the last things trained back, and most people stop before that part is done. One Assessment and Treatment is a single 45-minute appointment at $230, nett, no GST. Your therapist finds what is actually limiting you, treats it in the same appointment, and you leave with your current stage and a written plan.
Prefer to phone? Each of our five clinics has its own number on the clinics page. No referral needed to book.
What our patients say
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Related reading
Sources: 1. Alfredson H, Pietilä T, Jonsson P, Lorentzon R. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med. 1998;26(3):360-366. 2. 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. Br J Sports Med. 2008;42(9):746-749. 3. Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med. 2007;35(6):897-906. 4. Martin RL, Chimenti R, Cuddeford T, et al. Achilles pain, stiffness, and muscle power deficits: midportion Achilles tendinopathy revision 2018. J Orthop Sports Phys Ther. 2018;48(5):A1-A38.
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