Achilles tendon pain

What is it

Pain from the Achilles tendon is extremely common. There are two main types, the first is where the tendon itself is the pain generator, the second is where the tendon attaches to the heel bone (calcaneum).

Non-surgical options


This is treated well with physiotherapy, and if this does not work shock-wave therapy can be useful.


This is treated with off-loading (not resting on the sore area, putting a softer heel in your shoe). Sometimes physiotherapy can help, but often this is best treated with an operation.

Surgical options


In severe case surgical debridement can be considered.


The extra bony bump at the back of heel can be removed and the attachment of the Achilles taken off, cleaned, and reattached. A animation of the technique can be seen below:

Risks of surgery

All surgical procedures carry some risk. These risks are usually rare, but can include infection, bleeding, damage to surrounding structures such as tendons or nerves, numbness, dysfunction of foot, ongoing pain, unsightly scar, painful scar, wound healing problems, swelling. There is also a risk that the procedure does not work fully and that the patient is left with some ongoing symptoms.

There are also some medical risks to surgery such as a clot in the leg (DVT), clot in the lung (pulmonary embolus or PE). The general anaesthetic has rare risks of problems such as heart attack, stroke, chest infection and in extremely rare circumstances, death.

There is a hypothetical complication of tendon pull-off, but this is incredibly rare.

What to expect after surgery

  • This will be done as a day case procedure under a general anaesthetic.
  • A local anaesthetic block is used around the ankle to decrease post-operative discomfort.
  • The patient is discharged home from hospital on the day of the operation with painkillers to use as necessary.
  • The patient must keep their foot up above the level of the groin for 23 hours every day for two weeks. This minimises swelling, decreases discomfort and reduces the risk of wound complications and infection.
  • The recovery is normally managed in accordance with the Tendo-achilles rehabilitation protocol.

Expected recovery milestones

The post-op Achilles tendon rehab protocol can be downloaded here.