• Aug 21, 2025
• By TJICLondon

Chronic Achilles Tendinopathy: Why It’s Hard to Heal and New Treatments That Help

Achilles tendon pain is one of the most stubborn and frustrating injuries an active person can face. It affects runners, athletes, and even people who simply enjoy long walks or recreational sports. For many, the condition lingers for months or even years, making it hard to stay active. This is what’s known as chronic Achilles tendinopathy - and it’s notoriously difficult to treat.

The good news? There are now better treatment options available than ever before, including innovative injections such as PRP for Achilles and high-volume injections. In this article, we’ll break down why the Achilles tendon is so tricky to heal, and what treatments — both traditional and advanced — are available.

What is Chronic Achilles Tendinopathy?

The Achilles tendon is the thick, strong band of tissue that connects your calf muscles to your heel bone. It’s the largest tendon in the human body and is vital for walking, running, and jumping. Despite its strength, it can become injured through overuse or sudden strain.

Tendinopathy is not the same as acute tendonitis. While tendonitis refers to short-term inflammation after an injury, chronic Achilles tendinopathy involves degeneration of the tendon fibres over time. Instead of a straightforward injury that heals, the tendon becomes weakened and develops small tears and changes in structure.

People with chronic Achilles tendinopathy often report:

• Persistent pain and stiffness in the back of the heel or lower calf.

• Morning pain that eases with movement.

• Swelling or thickening of the tendon.

• Pain that worsens with activity such as running, climbing stairs, or jumping.

Why Tendinopathies Persist

One of the reasons Achilles injuries can last so long is the tendon’s poor blood supply. Compared to muscles, tendons receive much less blood flow, which means they heal much more slowly.

Other factors that make chronic tendon injury treatment challenging include:

• Overuse and repetitive stress: Activities like running, tennis, or football put constant strain on the tendon. Without enough rest, tiny microtears accumulate.

• Age-related changes: As we get older, the collagen fibres in tendons become less flexible and more prone to injury.

• Biomechanical issues: Flat feet, high arches, or poor footwear can increase stress on the Achilles tendon.

• Delayed treatment: Many people try to “push through” the pain, which often makes the condition worse.

All of these factors combine to explain why chronic Achilles tendinopathy doesn’t just disappear after a few weeks of rest. Instead, it often requires a structured treatment plan.

Conservative Treatments

Most treatment plans begin with conservative approaches, which are aimed at reducing pain and gradually strengthening the tendon. Some of the most widely recommended include:

1. Eccentric Exercises

These are specialised strengthening exercises where the calf muscle lengthens while under tension (such as slowly lowering your heel below the step on a staircase). Research shows that eccentric loading can stimulate tendon healing and is often the cornerstone of Achilles rehab.

2. Rest and Load Management

Completely stopping activity isn’t always necessary, but reducing high-impact sports and gradually reintroducing exercise is important. Switching to lower-impact activities like cycling or swimming may help while the tendon recovers.

3. Shockwave Therapy

Extracorporeal Shockwave Therapy (ESWT) uses sound waves applied to the tendon. This can stimulate blood flow and healing, and some patients report reduced pain after several sessions.

4. Supportive Measures

Heel lifts, orthotics, and proper footwear can reduce strain on the tendon. Anti-inflammatory medications may ease symptoms, though they don’t address the underlying degeneration.

While these methods work for many, some people continue to struggle with pain — especially if the condition has lasted more than 6 months. That’s where advanced options come in.

Advanced Injection Therapies

When conservative treatments aren’t enough, newer approaches such as PRP for Achilles tendinopathy and high-volume injections are becoming increasingly popular. These aim to tackle the problem at its root and encourage true tendon healing.

High-Volume Injection (Saline Injections)

A high-volume injection for Achilles tendinopathy involves injecting a large volume of sterile saline (salt water), sometimes combined with local anaesthetic and a small amount of corticosteroid, around the affected tendon under ultrasound guidance.

The theory is that the fluid helps to:

• Mechanically disrupt new, painful nerve endings that grow around damaged tendons.

• Reduce pain signalling.

• Allow the tendon to move more freely and respond better to rehabilitation exercises.

Patients often report pain relief after the procedure, which makes it easier to commit to physiotherapy and proper rehabilitation.

Platelet-Rich Plasma (PRP)

PRP injections use a patient’s own blood, spun in a centrifuge to concentrate the platelets — cells rich in growth factors that promote healing. Injected directly around the Achilles tendon under ultrasound, PRP may help stimulate tissue repair and collagen regeneration.

Although research is ongoing, many specialists consider PRP for Achilles a promising option, particularly for stubborn cases where other treatments have failed.

Both PRP and high-volume injections are quick, outpatient procedures done with ultrasound guidance for precision. Recovery usually involves a short period of rest, followed by a structured exercise programme.

Outlook and Prevention

Living with chronic Achilles tendinopathy can be discouraging, but most people do improve with the right combination of treatments. The key is patience and persistence. Tendons take time to adapt and heal.

To prevent recurrence:

• Stick to your rehab plan. Eccentric exercises should remain part of your weekly routine even after pain improves.

• Gradually return to sport. Avoid sudden spikes in training load. Increase distance, speed, or intensity slowly.

• Wear supportive shoes. Good footwear and, if needed, orthotics reduce strain.

• Listen to your body. Morning stiffness or twinges after activity are early warning signs — don’t ignore them.

With the right balance of conservative care and advanced therapies, chronic Achilles tendon pain doesn’t have to be permanent.

Final Thoughts

Chronic Achilles tendinopathy is a tough injury to beat, but modern treatment options mean there’s more hope than ever. From eccentric rehab to high volume injection for Achilles and PRP therapy, patients now have choices that can speed up recovery and get them back to the activities they love.

If you’ve been struggling with Achilles tendon pain for months, don’t wait any longer — seek advice from a specialist. With proper guidance and the right treatment plan, long-term relief and full recovery are achievable.