Medically reviewed by Dr. Tom Biernacki, DPM
Board-certified podiatric surgeon | Balance Foot & Ankle, Howell & Bloomfield Hills, MI
Last reviewed: May 2026
| Exercise | Target Structure | Sets × Reps | Frequency | Key Technique Point |
|---|---|---|---|---|
| Eccentric heel drop (straight knee) | Gastrocnemius (upper calf) | 3 × 15 | Twice daily, 7 days/week | Lower SLOWLY (3 sec); use both feet to rise |
| Eccentric heel drop (bent knee) | Soleus (lower calf, deeper) | 3 × 15 | Twice daily, 7 days/week | Slight knee bend; same slow lowering |
| Isometric calf hold | Tendon pain modulation | 5 × 45 sec holds | Daily (especially pre-activity) | On flat floor; moderate load; immediate pain relief effect |
| Single-leg calf raise (progressive) | Calf-Achilles strength | 3 × 12–15 | 3× per week (after 8+ weeks of eccentric) | Full range; add load when 3×15 feels easy |
| Ankle dorsiflexion mobilization | Ankle joint range of motion | 2 × 20 reps | Daily | Knee-to-wall stretch; monitor 10 cm distance |
| Hip and glute strengthening | Offload Achilles via kinetic chain | 3 × 12 | 3× per week | Single-leg deadlift, hip thrust, clamshells |
| Achilles Tendinopathy Location | Exercise Protocol Modification | Avoid |
|---|---|---|
| Mid-portion (2–6 cm above heel) | Standard Alfredson eccentric protocol as above | Nothing — full range heel drop is appropriate |
| Insertional (at heel bone) | Eccentric drop only to neutral (floor level), NOT below step edge | Below-neutral heel drop — compresses tendon on calcaneus |
| Acute (<6 weeks of symptoms) | Start with isometric holds; introduce eccentric gradually | Aggressive loading in first 2 weeks |
| Post-Achilles rupture repair | Formal physiotherapy protocol only; not self-directed | Any unsupervised loading until cleared by surgeon |
Quick answer: Achilles Tendonitis Exercises is a common foot/ankle topic that affects many patients. The 2026 evidence-based approach combines proper diagnosis, conservative-first treatment, and escalation only when needed. We treat this regularly at our Howell and Bloomfield Hills practices. Call (810) 206-1402.
Medically Reviewed | Dr. Tom Biernacki, DPM | Board-Certified Podiatrist | Balance Foot & Ankle, Michigan
The most important clinical decision with Achilles Tendonitis Exercises isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
The most important clinical decision with Achilles Tendonitis Exercises isn’t which treatment to start with — it’s identifying the correct subtype. That changes everything. Call (810) 206-1402.
Why Exercise Is the Primary Treatment
Achilles tendinopathy — chronic pain and dysfunction of the Achilles tendon — responds better to therapeutic exercise than to rest, anti-inflammatory drugs, or passive treatments alone. The tendon is metabolically active and responds to mechanical loading by reorganizing collagen fibers and increasing strength.
The Alfredson Eccentric Protocol (Gold Standard)
Swedish orthopedic surgeon Håkan Alfredson published this protocol in 1998 and it remains the most-studied intervention for midportion Achilles tendinopathy.
Exercise: Eccentric Heel Drop
Setup: Stand with the ball of both feet on a step, heels hanging off. Hold a wall or railing for balance.
Concentric phase: Rise up on both feet to the top position.
Eccentric phase: Shift weight to the affected leg, slowly lower the heel below the step level over 3 seconds. This is the therapeutic portion.
Repeat with knee straight: Targets the gastrocnemius. Then repeat with the knee slightly bent: targets the soleus.
Dose: 3 sets × 15 reps, twice daily, 7 days/week for 12 weeks.
Key point: The original protocol prescribed exercising through pain (not sharp/disabling pain). This counterintuitive approach is important — pain during loading is acceptable and expected initially.
Heavy Slow Resistance (HSR) Training
HSR training uses calf raises with added weight (loaded standing calf raise machine or weighted backpack) at slow tempo (3 seconds up, 3 seconds down). Research shows HSR equals eccentric loading in outcomes but patients find it more acceptable and report better satisfaction.
Progression: Start with body weight. Add load every 1–2 weeks as tolerated. Target 6 RM (weight you can lift only 6 times).
Insertional Achilles Tendinopathy: Different Protocol
For pain at the bone insertion (rather than 2–6 cm above), avoid heel drops below neutral — the increased tendon stretch at end range aggravates the insertion. Keep exercises in the range of neutral to plantar flexion.
Supporting Exercises
Hip strengthening (glute bridges, clamshells) reduces load on the Achilles tendon during running. Single-leg balance improves proprioception. Calf stretching should be gentle — aggressive stretching of an irritated Achilles may worsen symptoms.
Timeline
Pain typically increases during the first 2–4 weeks of eccentric training before improving. Most patients see meaningful improvement at 6–8 weeks and significant improvement at 12 weeks. Full tendon remodeling takes 3–6 months.
Frequently Asked Questions
Should I rest completely with Achilles tendonitis?
Prolonged rest worsens tendinopathy by reducing tendon load capacity. Relative rest (reducing aggravating activities while maintaining therapeutic loading) is recommended.
Can I run with Achilles tendonitis?
Running can continue if pain is below 5/10 during activity and returns to baseline within 24 hours after. Significant pain increases or morning stiffness worsening are signals to reduce load.
Michigan Foot Pain? See Dr. Biernacki In Person
Same-week appointments at our Howell and Bloomfield Hills offices.
📞 (810) 206-1402 Book Online →When Shoes Aren’t Enough — Dr. Tom’s Top 9 Orthotics
About 30% of patients I see for foot pain need MORE than a great shoe — they need a structured insole. Below: my complete 2026 orthotic ranking with pros, cons, and the specific patient I’d give each one to.
Best All-Purpose Orthotic for Most Patients
Semi-rigid arch shell + dual-layer cushion + deep heel cup. The orthotic I’ve fitted to more patients than any other for 15 years. APMA-accepted. Trim-to-fit design works in athletic shoes, casual shoes, and most work boots.
![Achilles Tendonitis & Back of Heel Pain [BEST Home Treatments 2024!]](https://www.michiganfootdoctors.com/wp-content/cache/flying-press/d645ea3f3d27024136b88a074b2b7894.jpg)
Watch: Achilles Tendonitis & Back of Heel Pain [BEST Home Treatments 2024!] — MichiganFootDoctors YouTube
✓ Pros
- Semi-rigid arch shell provides true biomechanical correction
- Deep heel cup centers the heel and reduces lateral instability
- Dual-layer cushion (top + bottom) lasts 9-12 months daily wear
- Available in 8 sizes for precise fit
- APMA-accepted and clinically validated
- Lower price than PowerStep Pinnacle Green for equivalent function
✗ Cons
- Too thick for most dress shoes (use ProTech Slim instead)
- Some break-in period required (3-7 days for arch tolerance)
- Not enough correction for severe pes planus or rigid pes cavus
Dr. Tom’s Recommendation: If a patient has run-of-the-mill plantar fasciitis, mild flat feet, or arch fatigue, this is the first orthotic I try. Better value than PowerStep Pinnacle for 90% of patients, which is why I swapped it into our clinic kits three years ago. Sub-$50 typically.
Maximum Motion Control · Flat Feet & Severe Over-Pronation
PowerStep’s most aggressive stability orthotic. Adds a 2°-7° medial heel post on top of the standard PowerStep platform — designed specifically for flat-footed patients and severe pronators who need real corrective force.
✓ Pros
- 2°-7° medial heel post adds aggressive pronation control
- Same trusted PowerStep arch shell, more correction
- Built specifically for flat-foot biomechanics
- Excellent for posterior tibial tendon dysfunction (PTTD)
- Removable top cover for cleaning
✗ Cons
- Too aggressive for neutral-arch patients
- Needs longer break-in (10-14 days) due to stronger correction
- Adds 2-3 mm of stack height — won’t fit slim dress shoes
Dr. Tom’s Recommendation: When a patient comes in with significant flat feet AND symptoms (heel pain, arch pain, knee pain), the Original PowerStep isn’t aggressive enough. The Maxx is what gets prescribed. About 25% of my flat-footed patients end up here.
Low-Profile · Fits Dress Shoes & Narrow Casuals
3 mm slim profile with podiatrist-designed tri-planar arch technology. Engineered specifically to fit inside dress shoes, oxfords, loafers, and women’s flats without crowding the toe box. Vionic was founded by an Australian podiatrist.
✓ Pros
- 3 mm slim profile (vs 7-10 mm for standard orthotics)
- Tri-planar arch technology adds support without bulk
- Built-in deep heel cup despite slim design
- Fits dress shoes WITHOUT having to remove the factory insole
- Trim-to-fit · APMA-accepted
✗ Cons
- Less arch support than full-volume orthotics
- Top cover wears faster than thicker alternatives
- Not enough correction for severe foot deformities
Dr. Tom’s Recommendation: My default when a patient says ‘I need orthotics but I have to wear dress shoes for work.’ Slim enough to fit in oxfords and pumps without the heel sliding out. The single highest-impact change you can make for office workers with foot pain.
Built-In Metatarsal Pad · Morton’s Neuroma · Ball-of-Foot Pain
Standard Pinnacle orthotic with a built-in metatarsal pad positioned proximal to the metatarsal heads — the exact location that offloads neuromas and metatarsalgia. No need for separate met pads or pad placement guesswork.
✓ Pros
- Built-in met pad eliminates DIY pad placement errors
- Specifically designed for Morton’s neuroma + metatarsalgia
- Same trusted PowerStep arch + heel cup platform
- Top cover protects sensitive forefoot skin
- Faster relief than orthotics + add-on met pads
✗ Cons
- Met pad position is fixed (can’t fine-tune individual placement)
- Some patients with very small or very large feet need custom
- Slightly thicker than the standard Pinnacle
Dr. Tom’s Recommendation: If a patient has Morton’s neuroma, sesamoiditis, or generalized ball-of-foot pain (metatarsalgia), this saves a clinic visit and a prescription. The built-in pad placement is anatomically correct for 80% of feet. Way better than DIY met pads.
Adaptive Dynamic Arch · Athletic & Daily Wear
Currex’s flagship adaptive arch technology — the orthotic flexes with your gait instead of fighting it. Different stiffness zones along the length give you targeted support at the heel, midfoot, and forefoot. Available in three arch heights (low/medium/high).
✓ Pros
- Dynamic flex zones adapt to natural gait cycle
- Three arch heights ensure precise fit
- Lighter than rigid orthotics (no ‘heavy foot’ feel)
- Excellent for runners and athletic walkers
- European podiatric design (German engineering)
✗ Cons
- More expensive than PowerStep Original ($55-65 typically)
- Less aggressive correction than Pinnacle Maxx for severe cases
- Three arch heights means you must self-select correctly
Dr. Tom’s Recommendation: I started recommending Currex three years ago for runners who said PowerStep felt ‘too rigid.’ The dynamic flex zones respect natural gait. Best for active patients who walk 8K+ steps daily and don’t need maximum motion control.
Running-Specific · Heel Strike + Forefoot Strike Compatible
Currex’s purpose-built running orthotic. The midfoot flex zone is positioned for runner’s gait mechanics, with a flared heel cushion for heel strikers and a forefoot rocker for midfoot/forefoot strikers. Tested on 1000+ runners during product development.
✓ Pros
- Designed by German biomechanics lab specifically for runners
- Dynamic arch flexes with running gait (not static like PowerStep)
- Three arch heights (low/medium/high)
- Reduces overuse injury risk in mid-distance runners
- Lightweight (no impact on cadence)
✗ Cons
- Premium price ($60-75)
- Not aggressive enough for severe over-pronators (use Pinnacle Maxx)
- Runner-specific design = less ideal for daily walking shoes
Dr. Tom’s Recommendation: If a patient runs 20+ miles per week and has plantar fasciitis or shin splints, this is the orthotic I prescribe. The dynamic flex zones respect running biomechanics in a way that no rigid PowerStep can match. Pricier but worth it for serious runners.
Cavus Foot & High-Arch Patients
Polyurethane base with a deeper heel cup and higher arch profile than PowerStep — built for cavus (high-arched) feet that need maximum cushion and support. The 5-zone cushioning system addresses the unique pressure points of high-arch feet.
✓ Pros
- Deeper heel cup centers the heel for cavus foot stability
- Higher arch profile fills the void under high arches
- 5-zone cushioning addresses cavus foot pressure points
- Polyurethane base lasts 12+ months
- Available in Wide width
✗ Cons
- Too tall/aggressive for normal or low arches
- Won’t fit slim dress shoes
- Pricier than PowerStep Original
- Some patients find the arch height uncomfortable initially
Dr. Tom’s Recommendation: Cavus foot patients are often misdiagnosed and given low-arch orthotics — that makes everything worse. Spenco’s Total Support has the arch profile that high-arch feet actually need. About 15% of my patients have cavus feet; this is what they wear.
Cushion Layer · Standing All Day · Gel Pressure Relief
NOT a true biomechanical orthotic — this is a cushion insole. But for patients who want gel pressure relief instead of arch correction (or to add ON TOP of factory insoles in work boots), this is the best gel option on Amazon.
✓ Pros
- Genuine gel cushioning (not foam pretending to be gel)
- Targeted gel waves under heel and ball of foot
- Trim-to-fit · works in most shoe types
- Sub-$15 price (most affordable option in this list)
- Massaging texture is genuinely soothing
✗ Cons
- ZERO arch support — this is cushion only
- Won’t fix plantar fasciitis or flat-foot issues
- Compresses faster than PowerStep (4-6 months)
- Top cover wears through in high-mileage applications
Dr. Tom’s Recommendation: I recommend these to patients who tell me ‘I just want my feet to stop hurting at the end of my shift’ and who don’t have a biomechanical issue. Construction workers, factory workers, retail. Pure cushion does the job for them.
Tight-Fitting Shoes · Cycling Shoes · Hockey Skates
PowerStep Pinnacle’s slim version of their famous Green insole. The trademark stabilizer cap is preserved but the overall thickness is reduced — works in cycling shoes, hockey skates, ski boots, and other tight-fitting footwear that the standard PowerStep Pinnacle Green can’t fit into.
✓ Pros
- Stabilizer cap centers the heel (PowerStep Pinnacle’s signature feature)
- Slim profile fits tight athletic footwear
- Lasts 12+ months daily wear
- Excellent for cycling shoes specifically
- Built-in odor-control treatment
✗ Cons
- Premium price ($45-55)
- Less cushion than PowerStep equivalents
- Not as aggressive correction as Pinnacle Maxx for flat feet
- The signature ‘heel cup feel’ takes 1-2 weeks to adapt to
Dr. Tom’s Recommendation: If you’re a cyclist with foot numbness, hot spots, or knee pain — this is the orthotic. The stabilizer cap solves cycling-specific biomechanical issues that no other orthotic addresses. Worth the premium for athletes.
None of these solving your foot pain?
Some patients (about 30%) need custom-molded prescription orthotics. We make 3D-scanned custom orthotics in our Howell and Bloomfield Hills offices — specifically built for your foot mechanics.
Schedule a Custom Orthotic Fitting →FSA/HSA eligible · Most insurance accepted · (810) 206-1402
Achilles Tendon & Posterior Heel Pain
⚕ Doctor Recommended
Doctor Hoy’s Natural Pain ReliefTopical relief for foot & ankle pain
View Product →In-Office Treatment at Balance Foot & Ankle
If home treatment isn’t providing relief for your Achilles tendonitis, our podiatry team at Balance Foot & Ankle can help with same-day evaluations and advanced in-office care.
OrthoInfo – AAOS: Achilles Tendinitis
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Or call: (810) 206-1402
Dr. Tom Biernacki, DPM is a board-certified foot & ankle surgeon (ABFAS & ABPM) 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 made him one of the most-followed foot & ankle educators on YouTube.