Midportion achilles tendon pain

Figure 1

As you can read in the general blog about Achilles tendon, there are several types of Achilles tendon complaints. This article is only about the midportate achilles tendon tendinopathy. Mid-achilles tendon complaints are located in the narrow part of the Achilles tendon between 2 and 7cm above the heel bone. As shown in figure 1.

What is tendinopathy?

Tendinopathy is degeneration of tendon tissue. This can happen not only in the Achilles tendon but also in the patella tendon or in other tendons in the body. Tendons, like many other structures in the body, are constantly building and breaking tissue. This happens in bones, ligaments, muscles and tendons. It is a balance between the fabrication and degradation.

A good balance between structure and degradation is largely due to the way in which the tissue is loaded. If you load a tendon too much, this can lead to more breakdown than fabrication. The tendon tissue then begins to change its structure and becomes less strong.

No, your Achilles tendon is not inflamed

For a long time it was believed that Achilles tendons could become inflamed. However, this is not the case, if there is swelling, stiffness and redness on the tendon this is not due to inflammation but a reaction to protect the tendon. This ensures that you will be less used. As described earlier, degeneration of the tendon causes a weak tendon.

Different stages of Achilles tendon tendinopathy.  

Reactive tendinopathy: This is usually with an increase in training load. For example by walking more kilometers per week or more hills in the training. The tendon can be swollen and painful.

Degenerative tendinopathy: The degenerative tendinopathy is when there are complaints for a long time. At this stage the structure of the tendon has already changed a lot. With these complaints, the Achilles tendon can be swollen or bumps may form on the tendon. If you continue to exercise with this, there is a chance that the tendon will partially or completely tear. However, you have to go through it for a very long time.


Most runners describe the first symptoms as a slowly rising pain during and/or after walking. The symptoms gradually increase until there is pain at the start of running or even during daily activities.

Usually the pain is 2 to 7 cm above the heel bone. Often it is painful when the tendon is pinched. Activities in which the achilles are loaded are painful, such as climbing stairs, standing on the toes and of course running.

Sometimes there is swelling in the beginning of the complaints and later a thickened tendon. There may also be stiffness in the calf.

Treatment of reactive tendinopathy

You can assume that if you have acute complaints after a change or increase in training, you have reactive symptoms. What you have to do is to reduce the load to get the complaints under control. It is possible that you can train slowly if this does not hurt. Make sure you keep a close eye on whether the complaints have not increased the next day. Achilles tendons can in fact give a reaction 24 hours after loading. Can’t run pain free? Then take a few days rest and try the next 2 isometric exercises for the calf.

Exercise 1: Isometric M. Soleus holds
Execution: Stand on the toes, bend the knees to about 90 degrees and keep this position full for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3×10 repetitions per side.

Exercise 2: Isometric M. Gasctrocnemius holds
Execution: Stand on the toes, keep the knees stretched and hold this position for 15 seconds. Then slowly come back to the ground with the whole foot.
Reps: 3×10 repetitions per side.

Besides these exercises you can also use tools like:

1. A heel raise in all of your shoes, not just your running shoes. This allows you to reduce the tensile forces on the Achilles tendon. You can buy this at Run2Day.

2. Use kynesiotape that supports the calf / Achilles tendon. Have this applied by a professional. Use this especially in the beginning of the complaints and during the build-up of running.

3. Use a foamroller to reduce the tension in the calves, but do not do this on the tendon itself.

4. Use the treatment with Human Tecar. The Human Tecar promotes the recovery of the tendon from the inside! At Running Solutions we use the Human Tecar, the Tecar is also used by all top marathon runners like Eluid Kipchoge and Wilson Kipsang.

Are your complaints going down? Then build up the running again slowly. Follow the advice of your therapist. The tendon can in the first period after the Achilles tendon complaints react quickly again if you build up too quickly.

Treatment of degenerative tendinopathy

These are the Achilles tendon complaints that have existed for some time. With these complaints, the tissue of the tendon has clearly degenerated and the recovery takes much more time than with the reactive variant.

With most of the degenerative tendinopathys, the damage can not be completely repaired. However, that does not mean that you can never run again. It is likely that you should always have a plan to keep the Achilles tendon symptoms under control.

Reducing and managing the load on the tendon is very important. If you continue to overload the tendon, chances are that the condition of the tendon deteriorates and eventually ends with a ruptured tendon.

In addition to controlling the load, you can use eccentric exercises for the calf. The idea of ​​these exercises is to give the tissue that is damaged in the tendon the right stimulus for recovery. This allows you to load more! The following two exercises are good as eccentric exercise:

Heeldrop extended knee:

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Wijzig keuze

Heeldrop bend knee:


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Wijzig keuze

t is then important to set up a program together with a specialized paramedic to train the calf muscles. This is much more than just the eccentric exercises.

Read more about the causes of Achilles tendon complaints in the general blog..

If you have complaints and need help? Please contact us!!