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 5 November 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.
At Phoenix, Achilles tendinitis is assessed and treated by our physiotherapy team at five clinics: Orchard, Tampines, Serangoon, Tanjong Pagar and Jurong East. The first visit is an Assessment & Treatment: one 45-minute appointment, one to one with a physiotherapist, $230 nett, no GST. No referral needed. WhatsApp 8336 6009 and we reply with a clinic and two times.
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.
First, the signs that mean a doctor, not this page
- 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.
None of these? Then the rest of this page is for you.
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 |
What else can feel like Achilles tendinitis?
Pain at the back of the heel is not always the tendon. These are the usual look-alikes, and who sorts them out.
| What you notice | What it can be | Who checks it |
|---|---|---|
| A sharp pain during a push-off, a tender spot in the tendon, and a heel raise that is suddenly much weaker | A partial Achilles tear | A doctor, with an ultrasound or MRI |
| Pain and puffiness just in front of the tendon at the heel bone, often with a bony bump that shoes rub | Retrocalcaneal bursitis, sometimes with a Haglund’s bump on the heel bone | A physiotherapist tests it. A doctor orders an X-ray if needed |
| Burning or tingling along the outer edge of the heel and foot | Irritation of the sural nerve | A physiotherapist or doctor |
| Deep pain at the back of the ankle when you point the foot hard, as in dance or kicking | Posterior ankle impingement | A physiotherapist tests it. A doctor orders imaging if needed |
| Pain or tingling that runs from the buttock or the back of the thigh down to the heel | Referred from the lower back | A physiotherapist or doctor |
| Both heels sore, with morning back stiffness or other swollen joints | An inflammatory condition affecting where tendons attach to bone | A doctor soon |
| Pain under the heel, worst on the first steps | Plantar heel pain, not the Achilles | 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.
Why it keeps coming back
You rested it for three weeks. The morning stiffness eased, so you ran. The next morning you went down the stairs one at a time, holding the rail, on your toes on that side.
So you rest again. The running shoes stay by the door. The Sunday long run is gone, the HYROX date or the race you entered is getting closer, and if you work on your feet, the last two hours of every shift are the worst.
The thinking is: rest it and it will heal. Here is what actually happened. Rest settled the pain. It did nothing for what the tendon can take. So the tendon met the same run with the same capacity as before, and gave the same answer.
Has anyone counted how many single-leg heel raises you can do on that side, against the other side? Or how many hops? If not, nobody knows whether the tendon is ready for a 5 km run, and that includes you.
If you have a race date or a return-to-work date, that is the clock that matters. It is yours, and the plan should be built back from it.
What the Assessment & Treatment does
Finding the real problem is half the battle. Treating it is the other half.
Your physiotherapist asks when it hurts, in your words, then tests what a label does not: where on the tendon it hurts, whether it is mid-portion or insertional, and whether one of the look-alikes above is joining in. If the tests point to a tear or anything that needs a doctor, we tell you and write to your doctor. Scans are theirs to order.
Then we measure the things that decide your plan:
- 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.
Most of the 45 minutes is treatment: hands-on work for the calf and ankle, the loading set at the level your tendon can take today, and your running or training rearranged inside the pain rule so you are not starting from zero. You leave knowing which stage you are in, what is limiting the tendon, what Stage 4 asks of it, and a written plan.
Tested, not dated. Hills and speed come back when the measures say so. Every appointment is one to one with the same physiotherapist for the full 45 minutes, with no therapy assistants. Bring the shoes you run or work in, and any scan report you have.
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.
Had an injection, or been offered one?
Injections for the Achilles are a decision between you and your doctor. If platelet-rich plasma (PRP) has been offered, two trials are worth knowing about. In 54 people with longstanding mid-portion Achilles tendinopathy, all doing a calf loading program, a PRP injection gave no more improvement than a saline injection at 24 weeks.5 In 240 people, a single PRP injection did no better than a sham needle at six months.6 If a steroid injection has been suggested, ask your doctor what the evidence and the risks are for the Achilles specifically.
Whatever is decided, the tendon still has to be loaded back to strength afterward. Your doctor sets how soon loading starts after an injection, and we follow it. More on physiotherapy after an injection.
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. Pain higher up, in the calf muscle, is a different problem, covered in calf pain.
Questions about Achilles tendinitis
Will Achilles tendinitis go away on its own?
Sometimes, if the load that set it off drops and stays down. Often the pain eases with rest and comes back when running or long standing returns, because rest settles the pain without building the tendon’s capacity. A loading program built up in steps is the treatment with the strongest evidence, and most people need about 12 weeks of it.
Is it Achilles tendinitis or tendinopathy?
The same problem under two names. Tendinitis suggests inflammation, but in longstanding cases the tendon shows changes in its structure more than inflammation, so clinicians now usually call it Achilles tendinopathy. The treatment is the same either way: load built up in steps.
Should I stretch my Achilles?
Gentle calf stretching is usually fine for mid-portion pain if it does not flare it. For insertional pain at the heel bone, hard stretching over a step usually makes it worse, because it squeezes the tendon against the bone. Strengthening, not stretching, is what changes the tendon.
Do I need a scan for Achilles tendinitis?
Usually not to start. It is diagnosed from where it hurts and how it behaves when tested. A doctor may order an ultrasound or MRI if a tear is suspected, an X-ray if there is a bony bump at the heel, or a scan if it has not improved after a well-run loading program.
Do I need a referral to see a physiotherapist for Achilles pain?
No. At Phoenix you can book a physiotherapist directly. If the assessment points to a tear or anything else that needs a doctor, your physiotherapist tells you and writes to your doctor.
Does a PRP injection help Achilles tendinitis?
That is a decision for you and your doctor. Two trials in longstanding mid-portion Achilles tendinopathy found a PRP injection did no better than a placebo, one at 24 weeks and one at six months. If PRP has been offered, those trials are worth asking your doctor about.
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
The morning stiffness is shorter than it was four weeks ago, and runs inside the pain rule are not making the next morning worse. That is a tendon on the right road. Keep the loading going for the full 12 weeks, even after the pain has gone, because the pain leaves before the strength comes back. You do not need us for this, and we would rather say so.
What our patients say
Google reviews from our clinics in Singapore.
2. It has stopped improving
The morning stiffness has not shortened in a month. Every return to running ends the same way, on the stairs the next morning.
That usually means the load and what the tendon can take are mismatched, and a mismatch is measured, not guessed. The Stalled Recovery Review is three appointments over three weeks with the same physiotherapist, because what a tendon 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
Surgery for Achilles tendinitis is uncommon. If you have had an Achilles operation, for a rupture or a tendon that would not settle, recovery has a shape and knowing which stage you are in tells you whether you are on it. See Achilles tendon rupture recovery and physiotherapy after surgery.
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 your tendon is in
Three weeks of rest, and the first steps out of bed still hurt? Get Assessed & Treated, and leave knowing which stage the tendon is in and what it can take this week.
Phoebe, our WhatsApp, replies with a clinic and two times. One 45-minute appointment, $230, nett, no GST. Bring the shoes you run or work in, and any scan report. Each of our five clinics also has its own number on the clinics page.
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. 5. de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, Tol JL. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144-149. 6. Kearney RS, Ji C, Warwick J, Parsons N, Brown J, Harrison P, Young J, Costa ML. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy: a randomized clinical trial. JAMA. 2021;326(2):137-144.
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