Achilles Tendinitis Treatment & Exercises 2026 | DPM

Location	Type	MRI Finding	Response to Eccentric	Notes
Non-insertional (mid-portion)	Most common; 2-7cm above insertion	Fusiform thickening; intrasubstance degeneration	Excellent — 60-90% success	Alfredson protocol most studied here
Insertional	At calcaneal insertion; often with Haglund	Enthesophyte; calcification; tendon thickening at bone	Moderate — eccentric may aggravate; HSR preferred	Retrocalcaneal bursitis often concurrent; avoid dorsiflexion past neutral
Peritendinitis	Paratenon inflammation; acute	Peritendinous edema; tendon often normal	Rest first; then eccentric once acute resolved	Responds well to NSAIDs + relative rest

Exercise / Treatment	Protocol	Evidence Level	Non-insertional	Insertional
Alfredson eccentric protocol	3×15 reps off step; knee straight + bent; twice daily x 12 weeks	Level I	60-90% success	Use with caution; limit range to neutral
Heavy slow resistance (HSR)	Seated + standing calf raises; slow tempo 3x/week x 12 weeks	Level I	Equivalent to eccentric	Preferred for insertional — avoids heel below step
Heel lift / orthotic	10-15mm heel raise; full-time 6-12 weeks	Level III	Adjunct; reduces load	Reduces Achilles tension; critical for insertional
ESWT (shockwave)	3-5 weekly sessions	Level I	65-80% improvement	70-80% improvement; excellent for insertional calcification
PRP injection	1-3 injections under ultrasound guidance	Level II	Refractory cases; mixed evidence	Emerging; may benefit calcific insertional tendinopathy
Surgical debridement	After 6-12 months failed conservative	Level II-III	70-85% return to sport	Removes degenerated tissue; Haglund resection for insertional

Quick answer: Treatment for achilles tendinitis treatment exercises recovery follows a stepwise approach: 1) conservative care first (rest, ice, supportive footwear, OTC anti-inflammatories), 2) physical therapy and targeted exercises, 3) in-office treatments (injections, custom orthotics) if conservative fails at 4-6 weeks, 4) surgery for refractory cases. Most patients resolve at step 1 or 2. Call (810) 206-1402.

https://www.youtube.com/watch?v=8opvH3qxkW4

Achilles tendinitis (more accurately termed Achilles tendinopathy in chronic cases) is inflammation or degeneration of the Achilles tendon — the largest and strongest tendon in the body, connecting the calf muscles to the heel bone. It is among the most common overuse injuries in runners, athletes, and active adults.

Insertional vs. Non-Insertional Achilles Tendinopathy

Non-insertional tendinopathy occurs 2-6 cm above the heel bone insertion, where blood supply is poorest and degeneration most common. This type responds best to eccentric exercise. Insertional tendinopathy occurs at the Achilles attachment to the heel bone, frequently associated with Haglund’s deformity (a bony prominence on the back of the heel) and heel bone bone spurs. This type is more stubborn to treat and may require different management including heel lifts and surgery in refractory cases.

Eccentric Heel Drop Exercise Protocol

The Alfredson eccentric heel drop protocol is the gold standard: Stand on a step with your heel hanging off the edge. Rise up on both feet, then slowly lower down on the affected foot alone (3 seconds down). Perform 3 sets of 15 repetitions twice daily, 7 days per week for 12 weeks. Initially painful — this is expected and acceptable. Discontinue if sharp or severe pain occurs.

Additional Treatment Options

Custom orthotics with heel lift reduce Achilles loading. Night splints maintain gentle dorsiflexion stretch during sleep. Corticosteroid injections — NOT directly into the tendon (risk of rupture) but around it — can reduce peritendinous inflammation. PRP (platelet-rich plasma) injections show promise for chronic tendinopathy. Extracorporeal shockwave therapy (ESWT) is FDA-cleared with good evidence for insertional tendinopathy.

Surgical Options

When 6+ months of conservative care fails, surgical debridement of degenerative tendon tissue with or without Haglund’s deformity removal is effective. Recovery takes 3-6 months but outcomes are excellent in appropriately selected patients.

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In-Office Treatment at Balance Foot & Ankle

If home treatment isn’t providing relief for your Achilles or tendon pain, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.