Achilles Tendon Pain Relief

Tendinitis versus tendinopathy

The distinction matters for treatment. Acute Achilles tendinitis involves genuine inflammation (redness, swelling and warmth) usually after a sudden spike in activity. Anti-inflammatory medication makes sense here. Chronic tendinopathy, which accounts for the majority of cases lasting more than six weeks, is primarily a degenerative process. The tendon structure breaks down at a cellular level. Inflammation is minimal, and NSAIDs alone will not fix it.

Your clinician can usually distinguish between the two on examination. Ultrasound imaging, available in many physiotherapy and podiatry clinics, confirms the diagnosis and shows whether the problem sits in the mid-portion of the tendon or at its insertion onto the heel bone. Treatment differs slightly for each location.

First-line medication

Ibuprofen 400 mg three times daily is the standard starting point for acute flares. It reduces pain and helps control early inflammatory changes. Keep courses short: seven to ten days. Naproxen (250-500 mg twice daily) offers a longer-acting alternative. Both should be taken with food.

Topical NSAIDs such as diclofenac gel or ibuprofen gel, applied over the tendon three to four times daily, deliver the drug locally with fewer systemic effects. A 2015 Cochrane review found topical NSAIDs effective for acute musculoskeletal injuries, with a number needed to treat of roughly four. They are a reasonable option for patients who want to avoid oral medication or who have gastric sensitivity.

Options for chronic or nerve-related pain

When Achilles pain grinds on for months, the character can shift. Some patients describe a burning or aching quality even at rest, particularly first thing in the morning. This suggests nerve involvement. The sural nerve and branches of the tibial nerve run close to the Achilles and can become irritated by a thickened, disorganised tendon.

Gabapentin (300-1200 mg daily) or pregabalin (75-300 mg daily) may be tried off-label in these cases. Evidence is extrapolated from neuropathic pain research rather than Achilles-specific trials, but clinicians report benefit in selected patients. Side effects include drowsiness and dizziness, so start low and increase gradually.

Muscle relaxants such as methocarbamol or baclofen can help when calf tightness or spasm contributes to tendon loading. They are best used short-term (one to two weeks) as an adjunct to physiotherapy, not as a standalone treatment.

These are examples of typical regimens. Your GP will determine the appropriate medication and dose based on the nature of your pain and any other conditions.

Are steroid injections safe for the Achilles?

Corticosteroid injection near the Achilles tendon is controversial. Unlike plantar fascia injections, which are relatively safe, injecting around the Achilles carries a documented risk of tendon rupture. A 2019 systematic review in the British Journal of Sports Medicine found that while short-term pain relief was achieved, the risk of rupture increased particularly with repeated injections.

Most sports medicine specialists and podiatrists avoid intratendinous injection entirely. Some use a carefully guided peritendinous injection (around, not into, the tendon) for insertional tendinopathy where other measures have failed. If offered a steroid injection for Achilles pain, ask whether the benefit outweighs the rupture risk in your specific case.

The exercise programme that actually works

Eccentric loading (the Alfredson protocol) remains the best-evidenced treatment for mid-portion Achilles tendinopathy. The exercise is simple: stand on the balls of your feet on a step, then slowly lower the heels below step level over a count of five. Three sets of 15 repetitions, twice daily, for 12 weeks. It should be mildly uncomfortable during the exercise. That is the point.

For insertional tendinopathy (pain at the back of the heel bone), isometric holds (pushing into a wall with the foot flat, holding for 45 seconds, five repetitions) are better tolerated initially. Progress to eccentric work once pain allows. Medication manages symptoms while this rehabilitation does the actual structural repair.

Other treatment options

Extracorporeal shockwave therapy (ESWT) has growing evidence for chronic Achilles tendinopathy resistant to exercise-based rehab. It is not widely available on the NHS but some private clinics offer it. PRP (platelet-rich plasma) injection has mixed evidence: some trials show benefit, others show no advantage over placebo. Surgical debridement or stripping of the paratenon is a last resort, reserved for patients who have failed at least six months of thorough conservative treatment.

Practical tips while recovering

A heel raise (5-10 mm silicone wedge) inside your shoe reduces stretch on the tendon during daily walking. Avoid flat shoes and going barefoot on hard floors, as both increase tendon load. Gradually increase activity; the tendon responds to load but punishes spikes. A useful rule: no more than a 10% increase in weekly running distance or standing time.

If symptoms persist, book a biomechanics assessment at our clinic (/services/footwear/) to identify contributing factors.

Further reading

If heel pain is under the foot rather than behind it, plantar fasciitis medication (/health-info/plantar-fasciitis-medication/) covers the right treatment approach.

For gait analysis and orthotic assessment, see our biomechanics service (/services/footwear/).

Disclaimer

This information is for educational purposes only and does not replace individual medical advice. Always consult your podiatrist, GP or physiotherapist before starting medication or a new exercise programme. A sudden sharp pain or audible snap in the Achilles tendon requires immediate medical assessment to rule out rupture.