Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatrist, Fellow of the American College of Foot and Ankle Surgeons. Updated April 2026.

Types of Achilles Tendon Pain

Achilles tendon pain encompasses a spectrum of conditions from mild tendinopathy (degenerative changes without structural tear) to complete rupture. The Achilles tendon—the largest tendon in the body, connecting the calf muscles to the heel—is subjected to enormous repetitive loads during walking, running, and jumping. Understanding the specific type of Achilles problem is essential for directing effective treatment, as different locations and mechanisms require different approaches.

Non-Insertional Achilles Tendinopathy

Non-insertional tendinopathy affects the mid-portion of the Achilles tendon—approximately 2–6 cm above the heel bone insertion. It produces a palpable thickening (tendon nodule) and pain in this zone, worst with morning first steps and at the start of activity, often improving with warm-up but worsening after prolonged exercise. It is primarily an overuse condition with degenerative changes (disorganized collagen, neovascularization) rather than inflammatory. Heavy eccentric calf exercises (Alfredson protocol: 3 sets of 15 reps twice daily, with progressive load over 12 weeks) have the strongest evidence for this type, achieving good outcomes in 60–85% of patients. Mid-portion tendinopathy responds poorly to stretching into dorsiflexion.

Insertional Achilles Tendinopathy

Insertional tendinopathy involves the Achilles at its insertion on the posterior calcaneus (heel bone) and is often associated with a posterior calcaneal spur (Haglund deformity—the bony prominence that rubs on shoe counters). Pain is at the back of the heel at the bone, worse with shoe pressure at the heel counter and with walking after rest. Unlike mid-portion tendinopathy, insertional disease responds poorly to eccentric loading into dorsiflexion—the compression of the tendon against the bone worsens symptoms. Heel lifts (3/8 to 1/2 inch) reduce Achilles tension at the insertion by plantarflexing the heel. Low-level laser therapy, extracorporeal shock wave therapy (ESWT), and deep massage are adjunctive options with supporting evidence.

Partial Achilles Tear

Partial Achilles tears occur within the tendon substance—usually in the setting of chronic tendinopathy—and present with sudden increase in pain, localized tenderness, and sometimes a palpable defect or gap. MRI differentiates partial from complete tears and guides management. Most partial tears are treated conservatively with immobilization followed by progressive loading. Large partial tears (>50% of tendon cross-section) may be managed surgically.

Complete Achilles Rupture

Complete Achilles rupture produces a sudden “pop” or snap—often described as feeling like being hit in the back of the leg—during explosive push-off (jumping, sprinting). The patient has significant difficulty or inability to push off or rise on the affected tiptoe. The Thompson test (squeezing the calf with the patient prone—absence of foot plantarflexion indicates rupture) is the most reliable clinical test. Acute complete rupture is managed with surgical repair or functional rehabilitation in a boot, with equivalent outcomes reported in selected patients. Surgical repair generally achieves faster return to sport in athletes and lower re-rupture rates in high-demand patients.

Frequently Asked Questions

Medical References & Sources

• PubMed Research — Eccentric Exercise for Achilles Tendinopathy (Alfredson)
• PubMed Research — Insertional Achilles Tendinopathy Treatment
• American Orthopaedic Foot & Ankle Society — Achilles Tendon

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He diagnoses and treats Achilles tendinopathy, partial tears, and complete ruptures with conservative management and surgical intervention.

Clinical References

1. Maffulli N, et al. Clinical Diagnosis of Achilles Tendinopathy With Tendinosis. Clin J Sport Med. 2003;13(1):11-15.
2. Alfredson H, Cook J. A Treatment Algorithm for Managing Achilles Tendinopathy. Br J Sports Med. 2007;41(4):211-216.
3. Silbernagel KG, et al. Eccentric Overload Training for Patients With Chronic Achilles Tendon Pain. Br J Sports Med. 2007;41(6):e1-e5.

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.