GPAtlas🧭 When to suspect
Achilles tendinopathy is a clinical syndrome characterised by focal pain, swelling, and impaired functional performance in the Achilles tendon. It is structurally characterised by disorganised collagen and neovascularisation rather than acute inflammation, making the term "tendinopathy" more accurate than "tendinitis".
Presentation is typically divided by anatomical location into mid-portion (2–6 cm proximal to the calcaneal insertion) and insertional (at the bone-tendon junction, often associated with a bony prominence or calcaneal spur). Mid-portion tendinopathy is significantly more common.
Suspect the diagnosis in patients presenting with a gradual onset of posterior heel pain that is classically worse after periods of inactivity. This "start-up" pain or morning stiffness – which often improves after a few minutes of walking – is a hallmark symptom. The condition frequently affects active individuals following a sudden increase in load (e.g. running distance, hill training), but also occurs in sedentary and overweight populations.
Source: BJGP · British Orthopaedic Foot and Ankle Society
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