What is Achilles tendinopathy?
The Achilles tendon is the largest and strongest tendon in the body, connecting the calf muscles (gastrocnemius and soleus) to the heel bone. It transmits the enormous forces generated by the calf during running, jumping, and walking - loads that can reach 6-8 times body weight during sprinting.
Achilles tendinopathy is degeneration and pain in the Achilles tendon from chronic overload. Like patellar tendinopathy, it is not simply inflammation - it involves structural changes to the tendon at a cellular level, with disorganised collagen, increased tendon thickness, and areas of poor vascularisation that impair healing. It presents in two locations: midportion tendinopathy (2-6 cm above the heel), which is most common in runners, and insertional tendinopathy (at the point where the tendon meets the heel bone), which is common in less active populations and those who sit for long periods.
Achilles tendinopathy is notorious for being ignored in its early stages. The morning stiffness that eases with walking, the mild ache that warms up during a run - these are signs that the tendon is accumulating damage faster than it can repair. Continued training through early symptoms without management is how a manageable issue becomes a long-term problem.
Understanding Achilles tendinopathy
Causes and contributing factors
- A rapid increase in running volume, speed, or hill work that exceeds the tendon's adaptive capacity
- Returning to sport after a period of inactivity without graduated reloading
- Tight or weak calf muscles (gastrocnemius and soleus) transferring excessive load to the tendon
- Sudden changes in footwear - particularly a reduction in heel drop (e.g. switching to minimalist shoes)
- Running on hills, particularly uphill, which dramatically increases Achilles load compared to flat running
- Fluoroquinolone antibiotics - a specific class of antibiotic associated with tendon weakening and tendinopathy
Symptoms to recognise
- Morning stiffness in the Achilles that eases within a few minutes of walking - the earliest and most important warning sign
- Pain in the tendon 2-6 cm above the heel, or directly at the heel bone insertion, that is tender to squeeze
- A painful nodule or thickening in the tendon in more established cases
- Pain that warms up with exercise and returns afterwards, progressing over weeks to pain during activity if untreated
- Occasional sharp pain or a feeling of the tendon "pinging" during sudden loading - a warning sign of possible partial tear
How Bearhug helps
The Bearhug ankle support provides compression to the lower Achilles and the heel, maintaining warmth in the tendon and improving circulation to a structure that has notoriously limited blood supply. Keeping the tendon warm reduces the stiffness and morning pain that characterises Achilles tendinopathy, and allows the tendon to begin each session in a better mechanical state.
The Bearhug calf support addresses the calf muscle complex that feeds the Achilles - reducing calf fatigue and the muscle tightness that increases Achilles tendon load. Used together, calf and ankle compression addresses the entire posterior chain from the calf to the heel, providing a comprehensive support approach for runners managing Achilles issues.
The gold standard rehabilitation exercise for Achilles tendinopathy is the eccentric heel drop on a decline board: slow, controlled lowering of the heel below step height under load. Performed consistently over 12 weeks, eccentric loading is among the most evidence-supported conservative treatments for midportion Achilles tendinopathy. Compression supports this process by keeping the tendon warm and maintaining circulation during the rehabilitation period.
The information on this page is provided for general guidance only and does not constitute medical advice. If you are experiencing pain or injury, please consult a qualified healthcare professional for a proper diagnosis and treatment plan. Bearhug products are Class 1 medical devices designed to support - not replace - medical treatment.