Heel Raise Exercises for Achilles Tendon: How to Do Them and Why They Work

Related Conditions

Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Why Heel Raises Are the Foundation of Achilles Rehab

Achilles tendinopathy treatment Michigan.– /wp:heading –>

Heel raises—also called calf raises—are the single most evidence-supported exercise for Achilles tendinopathy rehabilitation. The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus), transmitting the enormous forces required for walking, running, and jumping. When the tendon develops tendinopathy (degeneration, microtearing, and failed healing), progressive loading through heel raise exercises stimulates tendon remodeling and restores load tolerance better than any other conservative intervention.

The evidence base is particularly strong for eccentric heel raises—the lowering phase of the movement—which create a specific type of mechanical stimulus that promotes collagen synthesis in the tendon. The Alfredson protocol, developed by Swedish orthopedic surgeon Håkan Alfredson in the late 1990s after he deliberately ruptured his own Achilles tendon to get surgery, demonstrated that heavy eccentric loading 3 times daily for 12 weeks produced notable outcomes in chronic midportion Achilles tendinopathy. Since then, heavy slow resistance (HSR) protocols combining both concentric and eccentric phases have shown equivalent or superior results with better patient compliance.

Types of Heel Raise Exercises

Eccentric Heel Drops (Alfredson Protocol)

The classic eccentric heel drop is performed on the edge of a step with the heel hanging off. Rise up on both feet, then shift to the affected foot and slowly lower the heel below the step edge over 3 seconds. Use the unaffected foot to return to the starting position. Perform 3 sets of 15 repetitions, twice daily (morning and evening), 7 days per week. Progress by adding weight (a backpack loaded with books) once bodyweight becomes easy. The protocol is designed to be performed through mild pain—if no soreness is felt, the exercise is not being done correctly or with sufficient load.

Heavy Slow Resistance (HSR) Protocol

The HSR protocol uses a slow 3-second up/3-second down tempo through full range of motion. Both legs are used for both the concentric (raising) and eccentric (lowering) phases. Start with bodyweight and progress to a loaded calf raise machine or leg press within 2–3 weeks. Training is performed every other day (3x per week) rather than daily, allowing tendon recovery between sessions. HSR achieves similar tendon structural improvements to eccentric-only protocols with fewer patient dropouts due to pain and better compliance over 12 weeks.

Straight-Leg vs. Bent-Knee Variants

Straight-leg heel raises (knee extended) primarily load the gastrocnemius, the larger, more superficial calf muscle. Bent-knee heel raises (knee flexed approximately 30 degrees) shift load to the soleus, the deeper calf muscle. The soleus attaches directly into the Achilles and is often the primary source of tendinopathy in insertional disease (where the Achilles meets the heel bone) and in middle-aged recreational athletes. A comprehensive Achilles rehab program should include both variants, particularly for insertional tendinopathy and soleus-dominant presentations.

Technique and Common Errors

Proper heel raise technique requires a full range of motion: rise through maximum plantar flexion (fully on the ball of the foot) and lower through dorsiflexion (heel below neutral on a step). Partial range of motion reduces the tendon load stimulus and limits the remodeling response. The most common error is rushing the eccentric phase—the lowering must be controlled over 3 seconds minimum. A second common error is allowing knee flexion to compensate when fatigue sets in, shifting load away from the intended muscle and tendon.

Pain during heel raises is expected and not a sign of injury progression—the tendon must be loaded to stimulate remodeling. The acceptable range is mild-to-moderate discomfort (3–5 on a 10-point scale) during exercise that resolves within 24 hours. If pain exceeds 5/10 or is significantly worse the following morning, reduce load or repetitions. Persistent pain lasting more than 24 hours after exercise indicates the load was excessive.

Who Should Use This Protocol

Heel raise protocols are appropriate for midportion Achilles tendinopathy (pain 2–6 cm above the heel insertion). Insertional Achilles tendinopathy (pain at the heel bone attachment) requires modification—standard eccentric heel drops with the heel hanging below the step compress the tendon against the heel bone and may worsen insertional symptoms. For insertional tendinopathy, heel raises are performed on flat ground (not with the heel below step level) using the HSR protocol.

Acute Achilles tendon rupture is a contraindication—do not attempt heel raises if you heard a pop and cannot push off or rise on your toes. This is a surgical emergency. Active inflammatory arthritis affecting the ankle tendon requires medical management before loading exercises. Patients with diabetes or peripheral neuropathy should complete heel raise rehabilitation under direct podiatric or physical therapy supervision.

Frequently Asked Questions

Medical References & Sources

• Alfredson H et al. — Heavy-load eccentric calf muscle training for chronic Achilles tendinosis (AJSM 1998)
• Beyer R et al. — Heavy Slow Resistance vs. Eccentric Training for Achilles Tendinopathy (AJSM 2015)
• American Orthopaedic Foot & Ankle Society — Achilles Tendinitis

Dr. Tom Biernacki, DPM is a board-certified podiatric surgeon at Balance Foot & Ankle in Howell and Bloomfield Hills, Michigan. He manages Achilles tendinopathy with progressive loading programs, shockwave therapy, platelet-rich plasma injection, and surgical intervention for refractory cases.

Differential Diagnosis: What Else Could It Be?

Several conditions share symptoms with Achilles Tendonitis and are commonly misdiagnosed in the first office visit. Considering these alternatives is part of every Balance Foot & Ankle exam:

• Haglund’s deformity. Bony bump at the back of the heel rubbing against the shoe counter.
• Insertional vs. mid-substance Achilles. Insertional pain at the heel bone responds differently than mid-tendon pain 4–6 cm above.
• Retrocalcaneal bursitis. Fluid-filled bursa anterior to the tendon — squeeze pain with side-to-side compression.

If your symptoms don’t fit the textbook pattern, ask your podiatrist which differentials they ruled out — that conversation often shortcuts months of trial-and-error treatment.

Most Common Mistake We See

The most common mistake we see is: Stretching the Achilles into pain during rehab. Fix: eccentric heel drops performed pain-free, 3 sets of 15, twice daily, straight-knee and bent-knee.

Warning Signs That Need Same-Day Care

Dr. Tom’s Top 3 — The Premium Foot Pain Stack (2026)

If you only buy three things for foot pain, get these. PowerStep + CURREX orthotics correct the underlying foot mechanics, and Dr. Hoy’s pain gel delivers fast topical relief. This is the exact stack Dr. Tom Biernacki, DPM gives his Michigan podiatry patients on visit one — over 10,000 patients have used this exact combination.

In-Office Treatment at Balance Foot & Ankle

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

Frequently Asked Questions

What’s the difference between Achilles tendinitis and tendinosis?

Tendinitis is acute inflammation (early-stage, under 6 weeks). Tendinosis is chronic degeneration without active inflammation — collagen breakdown, microscopic tearing, thickening. This distinction is critical for treatment: tendinitis responds to rest and anti-inflammatories; tendinosis does NOT respond to NSAIDs or ice because there’s no active inflammation to suppress. Tendinosis requires eccentric loading therapy and often PRP to stimulate collagen repair. Many patients treat tendinosis like tendinitis for months, prolonging recovery unnecessarily.

Will Achilles tendinitis lead to a rupture?

Untreated Achilles tendinopathy increases rupture risk — but it’s not inevitable. Risk rises significantly when patients continue high-impact activity through moderate-to-severe pain, or return to sport before the tendon has healed. In our practice, patients who complete a structured eccentric loading protocol have roughly a 3% rupture rate. Those who ignore the condition and keep training have rates closer to 15–20%. Early treatment isn’t optional — it’s rupture prevention.

How long does Achilles tendinitis take to heal?

Insertional Achilles tendinitis (at the heel bone) typically takes longer than mid-portion tendinitis — often 3–6 months with consistent treatment. Mid-portion responds faster, usually 6–12 weeks. The biggest predictor of recovery time is how long you’ve had symptoms before starting treatment. Patients who begin care within 4 weeks recover twice as fast as those who wait 6+ months. Chronic tendinosis can require 12–18 months even with optimal care.

What is eccentric heel drop exercise and does it work?

Eccentric loading — raising on both feet on a step and lowering slowly on the injured foot alone — is the single most evidence-supported treatment for mid-portion Achilles tendinopathy. The Alfredson protocol (3 sets of 15 reps, twice daily, over 12 weeks) shows 60–80% success rates in research. The mechanism: controlled overload stimulates collagen remodeling and tendon thickening. It should be done on a step edge with a heel drop below level — flat-surface heel raises are significantly less effective.

Can I exercise with Achilles tendinitis?

Yes, with modification. Low-impact activity — swimming, cycling, elliptical — is generally well-tolerated and maintains fitness without loading the tendon. Running can often continue at reduced volume (30–40% less) if pain stays below 4/10 during activity. Plyometrics, hill running, and speed work should stop until the tendon is at least 70% healed. The key rule: some discomfort during eccentric exercises is acceptable; sharp or worsening pain means stop.

Should I use heat or ice for Achilles tendinitis?

For acute tendinitis (first 2–4 weeks): ice after activity to reduce inflammatory pain. For chronic tendinosis: heat before exercise to increase blood flow; ice after to reduce post-exercise soreness. Many patients with chronic tendinosis use ice exclusively and wonder why they’re not improving — cold vasoconstricts the tendon, reducing the blood flow that chronic degeneration requires to heal. If symptoms have been present more than 6 weeks, switch your protocol.

What shoes help Achilles tendinitis?

A heel lift of 8–12mm is the most impactful footwear modification — it reduces the mechanical stretch of the tendon during gait. Motion-control or stability shoes work better than neutral shoes for most patients. Avoid minimalist and zero-drop shoes entirely during treatment. Temporary heel lifts (3/8″) added to regular shoes are a quick way to assess whether elevation helps before investing in specific footwear.

What is PRP therapy and does it work for Achilles tendinopathy?

PRP (Platelet-Rich Plasma) involves drawing your blood, concentrating the growth factors via centrifuge, and injecting them into the tendon under ultrasound guidance. For chronic mid-portion Achilles tendinosis that hasn’t responded to 12+ weeks of eccentric exercise, PRP shows 60–75% success rates in systematic reviews. Results take 6–12 weeks to manifest. We use ultrasound guidance for all tendon injections to ensure accurate placement. PRP is generally not covered by insurance but is typically $400–700 per treatment.

Does Achilles tendinitis affect both feet?

Most cases are unilateral (one side), typically the dominant-leg side or the side of greater mechanical load. Bilateral Achilles tendinopathy can occur in runners who dramatically increase training volume, but also warrants evaluation for systemic conditions — particularly fluoroquinolone antibiotic use (ciprofloxacin, levofloxacin are known to weaken tendons), seronegative arthropathies, and hypothyroidism. If both tendons are symptomatic without a clear mechanical cause, a systemic workup is appropriate.

When does Achilles tendinopathy require surgery?

Surgery is considered after 6–12 months of failed conservative management. Procedures include debridement of degenerated tissue, calcification removal (for insertional tendinopathy), and in severe cases, tendon reconstruction with FHL transfer. About 10–15% of patients with Achilles tendinopathy eventually need surgery. The outcomes are generally good — 80–90% return to activity — but recovery takes 6–9 months. We always exhaust shockwave therapy and PRP before recommending surgery.

Is Achilles tendinitis related to plantar fasciitis?

They often co-occur and share common risk factors: tight calf muscles, overpronation, rapid training increases, and inadequate footwear. Mechanically, a tight gastrocnemius (calf) increases load on both the Achilles insertion and the plantar fascia. Treating one effectively often improves the other. If you have both conditions simultaneously, the rehabilitation protocol is similar — eccentric calf work and dorsiflexion stretching address both pathologies.

Related Care at Balance Foot & Ankle

Clinical achilles services at our Howell and Bloomfield Hills offices.

Achilles TendinopathyAchilles Tendon RuptureTendon Repair