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Achilles tendinopathy

Updated: May 31, 2020

anatomical illustration highlighting achilles tendon pain site

Achilles tendinopathy is an Achilles tendon pain. Achilles tendon problems are one of the most common lower limb problems cyclists encounter. It generally develops slowly over time as a pain felt at the back of the ankle. It is referred to as an overuse injury due to its slow onset and this is often why people ignore it until it gets severe, making it more difficult to treat and slower to recover.

Tendinopathy is the best current term to describe the changes that occur in the tendon but you may also see it referred to as tendonitis or tendinosis. The changes occur due to a change in the balance of 'WEAR' and 'REPAIR' processes within the tendon. It most commonly arises in the middle part of the tendon, about 5-8cm above the heel bone.

What causes Achilles tendinopathy?

Tendon problems are generally caused by changes in stress to the tendon. Most commonly a sudden increase in training / riding frequency or intensity following a period of less riding. This causes an imbalance in the tendon's response to the training which can affect the normal 'WEAR' and 'REPAIR' processes. The result can be minor inflammation, changes in tendon structure, and often pain that limits performance.

Risk Factors

  • Incorrect bike fit, a new bike, and new shoes / cleats

  • Previous tendon problems

  • Previous ankle injury

  • Calf muscle weakness

  • Age & Gender - more common in males and as we age

  • Obesity

  • Medical conditions such as; Type II Diabetes, Rheumatoid Arthritis, High cholesterol

What are the symptoms?

Start up pain

This is a pain or stiffness felt in the achilles in the morning or after periods of rest, e.g sitting down at work.


Pain normally remains very specifically around the tendon itself, either in the middle or closer to the attachment to the heel.


The pain will often be worse at the beginning of a cycle, then ease off, then come back later in the rider, and commonly be quite stiff or sore afterwards.

Clinical Diagnosis

A full assessment carried out by a physiotherapist or sports doctor combing history, physical examination and ultrasound scan.

How can I manage Achilles tendinopathy?

Activity Modification

The first step will always be to assess your current aggravating factors. If your cycling is causing tendon pain then you will need to start by reducing your mileage. Start by reducing the more intense sessions such as high intensity intervals or hill climbing sessions for example.


Under the guidance of a physiotherapist a structured and progressive loading programme to re-condition the tendon and ease the pain. These are best set-up, monitored, and progressed by an expert physiotherapist - with particular specialty in cycling.

Shockwave Therapy

There is good evidence to support the use of Extracorporeal Shockwave Therapy (ESWT) in the management of tendinopathy. It is considered to have very positive effects on tendon pain but also acting as part of a stimulus to assist in tendon healing and re-conditioning (alongside a structured training programme).

Bike Fit

There are many factors in your bike set up that can alter the forces going through your achilles tendon. Incorrect cleat set up and excessive saddle height are two of the more common problems we see with cyclists who have achilles issues but there can be many more. A comprehensive bike fit can address these matters and ensure that when you build your riding back up you don’t end up developing the same problem all over again.

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There is a never-ending list of other therapeutic modalities touted to help with tendon pain. Steroid injections were a mainstay over the past 20 years but there is now substantial evidence that the longer term outcomes are worse with steroid injection and there may also be an increased risk of tendon rupture. Taping, acupuncture, massage, cupping, injections of other solutions, all have limited, conflicting, or no evidence at all that they assist in tendon rehabilitation.

What else could it be?

  • Retrocalcaneal bursitis

  • Insertional achilles tendinopathy (enthesopathy)

  • Tibialis posterior tendon pain

  • Kager's fat pad impingement

  • Referred pain (from back / sciatica)

If you are having issues and want to get in touch about booking a consultation or a bike fit then please email us:

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