That first-step stiffness was supposed to settle.
You rested it.
Changed your running.
Stretched your calf.
Did the exercises.
Maybe you tried massage, physio, heel lifts, new shoes or an injection.
But your Achilles is still there
It may hurt every day. Or it settles just enough to give you hope, then flares when you add hills, speed, longer runs, jumping or even more walking.
If you are searching for why your Achilles tendonitis is not healing, the useful answer is not simply rest for longer.
Persistent symptoms do not automatically mean the tendon is permanently damaged or incapable of improving. They can mean the diagnosis needs checking, the current load is not matched to your capacity, the rehabilitation has stalled, or the return to activity has moved faster than the tendon was ready for.
If you want the diagnosis and plan assessed, start with Premier’s Achilles tendinopathy assessment or Tendon Clinic.
First: “tendonitis” and “tendinopathy” are not quite the same thing
People commonly use Achilles tendonitis to describe pain around the Achilles tendon. Clinicians often use the broader term Achilles tendinopathy for local tendon pain associated with loading activities.
The distinction matters because persistent Achilles pain is not adequately explained as inflammation that simply needs to disappear. It also does not mean every painful tendon is degenerating or unhealed.
The first job is to confirm whether the symptoms fit an Achilles-tendon presentation and whether the pain is in the mid-portion of the tendon, near its insertion at the heel, or coming from another structure.
Why your Achilles may not be getting better
1. The diagnosis may need another look
Pain at the back of the ankle is not always the same problem.
Mid-portion Achilles tendinopathy, insertional Achilles pain, bursitis, referred pain and other ankle or heel presentations can overlap. The location, behaviour and aggravating activities change the questions that need to be asked.
If your symptoms do not fit the expected pattern—or have not responded as expected—another assessment may be more useful than another random treatment.
2. Rest lowered the demand but did not rebuild capacity
Rest can reduce symptoms because the tendon is being asked to do less.
But running, jumping, hills, stairs and push-off still require capacity.
If activity drops for several weeks and then returns at its previous level, the gap between what the Achilles can tolerate and what you are asking it to do may still be there.
The aim is not to irritate it repeatedly. It is also not to protect it forever.
It is to find a suitable starting point and build from there.
3. The exercises may not have progressed far enough
I already did calf raises is something we hear often.
But an exercise is not a complete rehabilitation plan.
The starting exercise, resistance, range, speed, frequency and progression all matter. A program that was appropriate when walking was painful may not be enough to prepare someone for a long run, repeated jumps or fast changes of direction.
Current Achilles clinical guidance supports tendon-loading exercise as a central part of care for mid-portion Achilles tendinopathy. The program still needs to be matched to the person, presentation and goal.
4. Your whole week may be loading the tendon
Your Achilles does not only experience load during a rehabilitation session.
Running volume. Hills. Speed. Court sport. Gym work. Long shifts. Walking. A sudden change in footwear. A holiday with twice the usual steps.
Looking at one exercise without looking at the total week can miss why symptoms keep changing.
5. Pain settling is not the same as being ready
The tendon may feel better before it has rebuilt the strength and capacity needed for your full activity.
That creates the familiar cycle:
Pain settles → activity resumes → demand jumps → pain returns.
A clearer plan uses progression criteria rather than relying only on whether the tendon feels quiet today.
6. A useful treatment may be missing—or carrying too much of the plan
Hands-on treatment, footwear changes, taping, heel lifts, medication, injections and Shockwave Therapy can all enter the conversation in different circumstances.
But no single treatment replaces a clear diagnosis, load decisions and progressive rehabilitation.
For selected persistent Achilles presentations, Shockwave Therapy may be considered as one part of the plan. Evidence and suitability differ between mid-portion and insertional presentations, so it should follow assessment rather than being prescribed to everyone with Achilles pain.
Do you need to stop running completely?
Not automatically.
Some people need to reduce or temporarily change running. Others can continue selected training while their plan is adjusted.
The decision depends on the symptom response, current capacity, training demands and goal. The useful question is not simply Can I run? It is What amount and type of running makes sense right now—and how do I build from there?
Do you need a scan?
Not everyone with Achilles pain needs imaging before starting a plan.
Diagnosis is often guided by the history and clinical examination. Imaging may be useful when the diagnosis is uncertain, symptoms are unusual, another condition is suspected or the result would change management.
Bring any existing scans or reports to your appointment. You do not need to arrange a new scan simply to book.
What a useful Achilles assessment should answer
You should leave understanding:
- What is most likely causing the pain.
- Whether the presentation appears to involve the Achilles or something else.
- What your current strength and capacity look like.
- Which activities can continue and what should change initially.
- Where hands-on treatment, Shockwave Therapy or another treatment may fit.
- How rehabilitation will progress towards walking, running, work, gym or sport.
At Premier, a tendon appointment lasts 45–60 minutes and includes appropriate treatment on the first visit.
Your Achilles has not improved by repeating the same cycle
More waiting is not automatically the answer.
Another generic exercise sheet may not be the answer either.
Find out what may be keeping the problem going. Begin appropriate treatment. Build a plan towards the activity you want back.
Brunswick · Fitzroy North · Thornbury
Clinical references
- Chimenti RL et al. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024. Journal of Orthopaedic & Sports Physical Therapy. https://www.orthopt.org/content/s/achilles-pain-stiffness-and-muscle-power-deficits-midportion-achilles-tendinopathy-revision-2024
- de Vos RJ et al. Dutch multidisciplinary guideline on Achilles tendinopathy. British Journal of Sports Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC8479731/
- Paantjens MA et al. Extracorporeal Shockwave Therapy for Mid-portion and Insertional Achilles Tendinopathy: A Systematic Review of Randomized Controlled Trials. Sports Medicine – Open. https://pmc.ncbi.nlm.nih.gov/articles/PMC9106789/
