The Top 6 Reasons for Achilles Pain and What You Can Do About It

Are you tired of dealing with persistent and chronic Achilles pain?

There is research to show that there are many physical therapy treatments to decrease both acute and chronic Achilles pain. Chronic Achilles and heel pain is a very common complaint among many runners and non-runners with an incidence of 7-9% of all runners annually.  The tendon is predisposed to issues in runners, jumpers, and those that are highly inactive.  The tendon itself has decreased blood flow 5-9 cm up from the heel itself which is the most common site of tendon pain.

Many health care professionals call chronic Achilles pain tendinitis but research has shown that there is not actually inflammation but a breakdown of the tendon with irregular blood supply.  In the chronic stages it is actually called tendinosis.  Below are risk factors that lead to increased strain and breakdown on the tendon.

6 Research Shown Risk Factors For Achilles Pain

  1. Decreased dorsiflexion range of motion (ability to pull the foot towards the shin)
  2. Abnormal Subtalar joint motion (motion of the heel turning in and out)
  3. Decreased calf strength in both gastroc and soleus strength
  4. Increased pronation where the arch collapses when you put weight through your foot
  5. Other medical issues: High blood pressure, diabetes, smoking, and high cholesterol. These issues decrease the blood flow to the tendon and can lead to tendon breakdown.
  6. Hallux Rigidus or a stiff big toe. You need to have enough big toe extension to allow a normal gait pattern.


To summarize the above list if the joints in the foot and ankle are not allowing the lower leg bone (tibia) to move evenly over top of the foot or if the foot collapses into excessive pronation there will be a whipping trauma to the tendon instead of just tension like it is designed to withstand.

Achilles Pain Treatment

Treatment should consist of manual therapy to the joints of the foot and ankle, soft tissue work to the calf, and strengthening of the muscles that support your foot and control your knee so the Achilles doesn’t have abnormal loads placed up it.  Sometimes an orthotic in your shoes is necessary to control excessive pronation or different shoes entirely.

  1. Maintain adequate calf flexibility
  2. Maintain calf strength
  3. Have proper footwear and orthotics if necessary
  4. For runners: Don’t increase mileage or hills too quickly

Check out our blog post on running mileage for safe distance progressions


Call us if you have acute or chronic pain so we can get you on the road to recovery quickly.  At Holland Physical Therapy we will look at your hips, core, knees, ankles, and feet, looking for anything that could lead to injury.  We will give every patient a specific program for your injury to make you the best version of you.  Call us at 616-355-4284 or visit us at to get evaluated.

Ford Reinink PT, DPT

Director of Clinical Operations for Holland Physical Therapy

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