
Pain in the back of the heel can make simple movements feel difficult. Walking upstairs, jogging, pushing off the foot, or even getting out of bed in the morning may suddenly become painful. In many cases, the problem is Achilles tendonitis, also called Achilles tendinopathy.
The Achilles tendon connects the calf muscles to the heel bone. It is the strongest tendon in the body and helps with walking, running, jumping, climbing stairs, and standing on the toes. Because it handles so much force every day, the tendon can become irritated or overloaded over time.
Achilles tendonitis often develops gradually. Some people notice mild soreness after exercise that keeps returning. Others experience stiffness in the morning or pain after long periods of activity. Without proper treatment, the tendon can weaken and become more vulnerable to tearing.
Achilles tendonitis symptoms usually begin slowly and worsen over time if the tendon continues to be overloaded. Common signs include:
Pain along the back of the heel or lower calf
Stiffness in the morning
Tenderness when touching the tendon
Swelling around the Achilles area
Burning or aching pain after exercise
Difficulty walking, running, or climbing stairs
Increased pain after long periods of standing
Tight calf muscles
Pain during push-off movements
Some people feel discomfort directly where the tendon attaches to the heel bone. Others notice pain slightly higher up in the middle portion of the tendon. These are two different forms of Achilles tendinopathy:
Midportion Achilles Tendinopathy
This type affects the middle section of the tendon, usually a few inches above the heel. It is more common in runners and active adults.
Insertional Achilles Tendinopathy
This form occurs where the tendon attaches to the heel bone. It is often aggravated by uphill walking, tight shoes, or excessive calf stretching.
Achilles tendonitis is commonly linked to repeated strain on the tendon. The tissue becomes irritated when it is exposed to more stress than it can tolerate and recover from. Several factors may contribute to this condition.
Sudden Increase in Activity
Many injuries happen after someone rapidly increases running distance, workout intensity, or sports participation without allowing the body enough time to adapt.
Tight or Weak Calf Muscles
Limited flexibility and poor calf strength can place additional stress on the Achilles tendon during walking and exercise.
Sports and Repetitive Movements
Running, basketball, tennis, soccer, and jumping activities repeatedly load the tendon. Weekend athletes are especially vulnerable because the tendon may not be conditioned for sudden bursts of activity.
Foot Mechanics and Alignment Issues
Flat feet, high arches, leg length differences, and abnormal walking patterns can change how force travels through the tendon.
Poor Footwear
Worn-out shoes or shoes with inadequate support may increase tendon strain. Unsupportive flat shoes can also aggravate symptoms, especially in insertional Achilles tendonitis.
Age-Related Changes
As people age, tendons naturally become less flexible and less capable of handling repetitive stress. This increases injury risk in middle-aged and older adults.
Certain Medical Conditions and Medications
High cholesterol, obesity, psoriasis, and high blood pressure have all been associated with a greater risk of Achilles tendon problems. Some antibiotics, particularly fluoroquinolones, may also increase tendon injury risk.
Physical therapy is considered one of the most effective conservative treatments for Achilles tendonitis. A structured rehabilitation program helps the tendon gradually tolerate load again without causing additional irritation. At Clifton Physical Therapy, treatment plans are tailored to the patient’s symptoms, activity level, and goals.
Pain Reduction and Activity Modification
The first step is calming the irritated tendon. This may involve modifying activities that overload the Achilles, such as running, jumping, or hill climbing.
Patients are guided on how to stay active without worsening symptoms. Ice, supportive footwear recommendations, heel lifts, taping techniques, and manual therapy may also help reduce irritation.
Stretching Tight Calf Muscles
Limited calf flexibility can increase stress on the Achilles tendon. Gentle stretching exercises may improve ankle mobility and reduce excessive pulling on the tendon. Common stretches include:
Standing gastrocnemius stretch
Soleus stretch
Wall calf stretches
However, stretching must be prescribed carefully. Aggressive stretching may worsen insertional Achilles tendonitis in some individuals.
Progressive Strengthening Exercises
Strengthening the calf muscles and tendon is one of the most important parts of rehabilitation. Research consistently supports progressive loading exercises for improving pain and function. Treatment may include:
Heel raises
Eccentric calf strengthening
Soleus strengthening exercises
Resistance training
Balance and stability exercises
Functional movement training
Eccentric exercises, where the calf muscle lengthens under tension, are commonly used for midportion Achilles tendon pain. These exercises help the tendon adapt to stress more effectively over time.
Improving Walking and Movement Mechanics
Physical therapists evaluate walking patterns, ankle mobility, lower extremity alignment, and movement habits that may contribute to ongoing tendon irritation.
Correcting movement problems can reduce repeated stress on the tendon and improve long-term outcomes.
Gradual Return to Sports and Exercise
Returning to activity too quickly is one of the most common reasons symptoms return. Physical therapy helps patients safely progress back into running, sports, gym workouts, and daily activities while reducing reinjury risk.
Exercise plays a major role in Achilles tendon recovery. The goal is not simply to “stretch the tendon,” but to help it tolerate load again in a controlled and progressive way.
Standing Calf Stretch for the Gastrocnemius
This stretch targets the larger calf muscle, which connects directly into the Achilles tendon. To perform the stretch:
Stand facing a wall.
Place the injured leg behind you.
Keep the back knee straight and heel on the floor.
Bend the front knee and lean forward slowly.
Hold for about 30 seconds.
Soleus Stretch
The soleus is a deeper calf muscle that also contributes to Achilles tendon loading. To target this muscle:
Stand in a staggered stance facing a wall.
Slightly bend the back knee while keeping the heel down.
Shift weight forward until a stretch is felt lower in the calf.
Hold for 30 seconds.
Heel Raise Exercises
Heel raises strengthen the calf muscles and improve the tendon’s ability to tolerate force. Patients may begin with double-leg heel raises before progressing to:
Single-leg heel raises
Slow eccentric lowering exercises
Weighted calf raises
Bent-knee soleus heel raises
Eccentric Loading Exercises
Eccentric exercises involve slowly lowering the heel while the calf muscle lengthens under tension. These exercises are widely used in Achilles rehabilitation because they may help:
Improve tendon capacity
Reduce pain
Increase calf strength
Improve function during walking and running
Toe Walks and Balance Training
Toe walks activate both major calf muscles while also improving stability and foot control.
Balance exercises may also be added to improve lower extremity coordination and reduce stress on the tendon during movement.
Progressive Resistance Training
As symptoms improve, patients may progress into heavier strengthening exercises using gym equipment such as:
Leg press calf raises
Seated calf raises
Resistance machines
Functional strengthening drills
Continuing to overload the tendon can delay healing and increase the risk of a partial tear or rupture. Depending on the severity of symptoms, physical therapists may recommend temporarily reducing or modifying activities such as:
Running on hills or inclines
Sprinting
Jumping and plyometric exercises
Stair climbing workouts
Walking barefoot on hard surfaces
High-impact sports
Sudden increases in exercise intensity
Aggressive calf stretching during acute irritation
This does not mean complete rest is always necessary. In many cases, controlled movement and modified activity are better than total inactivity.
Recovery time varies depending on several factors, including:
Severity of tendon damage
Duration of symptoms
Activity level
Overall health
Adherence to treatment
Presence of biomechanical issues
Mild cases may improve within several weeks, while chronic tendon problems can take several months to recover fully.
Many patients begin noticing improvement within 6 to 8 weeks of consistent physical therapy and home exercise progression. More stubborn cases may require 3 to 6 months or longer.
Many people ignore Achilles pain until it becomes difficult to walk or exercise. Early treatment often leads to better outcomes and may help prevent more serious tendon injuries. You should consider seeking professional evaluation if you experience:
Persistent heel or calf pain
Morning stiffness that continues daily
Pain during walking or exercise
Swelling around the tendon
Symptoms lasting more than a few weeks
Difficulty pushing off the foot
Pain that worsens with activity
Recurrent Achilles problems
Achilles tendonitis is not always caused by a single injury. In many cases, it develops because the tendon gradually loses its ability to tolerate stress.
That is why treatment should focus on more than temporary pain relief. A comprehensive rehabilitation program helps address:
Tendon strength deficits
Reduced calf muscle capacity
Limited ankle mobility
Poor movement mechanics
Activity overload
Footwear issues
Return-to-sport progression
At Clifton Physical Therapy, rehabilitation programs are designed around each patient’s specific condition, lifestyle, and recovery goals. Whether the problem developed from running, sports, work demands, or daily activities, treatment focuses on helping patients move comfortably and confidently again.
Call Clifton Physical Therapy at (973)-241-1338 to schedule an evaluation and start your recovery.
"I recently had ankle surgery and Clifton PT has been nothing short of amazing! My goal was to get back to playing soccer as quick as possible before the college season started and so far I'm right on track. Izzy, Bianca, Tiff, and John have gone above and beyond to make sure I'm back to 100%. Couldn't be more grateful to be treated by the best team ever!." - Nat Rufino

All the therapists at Clifton Physical Therapy are awesome, but I spend most of my time with Izzy and Bianca—and they’ve been amazing. They’re enthusiastic, knowledgeable, and always take the time to explain what I’m doing and what my issues are. Their positive energy and clear communication make a big difference in my recovery." - Bryan Tompkins

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Clifton Physical Therapy
✆ Phone (appointments): (973)-241-1338
Address: 1059 Bloomfield Ave, Clifton, NJ 07012