What is Achilles Tendon Pain?

Inflammation of the Achilles tendon occurs from microtrauma to the fibres of the tendon. It presents with pain in and around the back of the ankle due to increased stress. This is associated with excessive or abnormal activity as well as pronation.

What is Pronation?

Pronation is the natural inward rolling of the foot at the ankle. Everyone pronates to some degree to absorb shock when standing, waking and running, however prolonged or excessive pronation of the foot can predispose individuals to injury.  Overpronation occurs when the ankle rolls more than normal and results in changes to the direction of the forces on the foot and leg. Causes of this can include:

  • Muscle tightness or weakness
  • Reduced coordination between the ankle and foot
  • Inappropriate footwear
  • Collapse of the arch of the foot (flat feet)


Although this condition is occasionally described as flat feet, it is in fact not a dysfunction of the arch of the foot, but instead involves excess movement at the joint.

It is suspected that overpronation may lead to people experiencing pain in the Achilles tendon due to reduced blood flow to the area.

An article in the Scandinavian Journal of Medicine and Science in Sports explored this theory with a study used to investigate Achilles tendon blood flow in individuals with overpronated feet compared to others with normal alignment in both non-weightbearing and weight-bearing positions.

They found that individuals with overpronation demonstrated:

  • Increased vascular resistance
  • Reduced Achilles tendon blood flow.

This was particularly evident in weight-bearing positions including 1 and 2-legged upright standing and in areas of the tendon that are commonly subjected to increased mechanical stress (mid-tendon and osseo-tendinous junction)

It was suggested that excessive pronation of the foot generates an internal rotation force on the tibia (shin bone) that draws the tendon medially. This produces a bowstring effect on the tendon that can squeeze the blood vessels, possibly leading to degeneration, reduced strength and rupture.

Therefore, poor blood flow to the Achilles due to excessive pronation can be a contributing factor to pain and injury.

Physiotherapy Management?

  1. Soft or Deep Tissue Massage
  • Facilitates healing in the tendon through breaking down and preventing further adhesions and thickening.
  • The manual manipulation of the tissue fibres surrounding the tendon will improve blood flow to the area
  • Results in eventual reduction of Achille’s pain
  1. Taping of the foot
  • To reduce the amount of overpronation
  • Taping has a positive biomechanical effect on foot position. Studies have reported notable increases in arch height, reductions in internal rotation of the tibia and changes in pressure patterns through the foot when standing, walking and running.

  1. Ankle Mobilisations
  • To improve range of motion (ROM) at the ankle
  • Begin with passive ROM exercises and progress to active ROM exercises.


  1. Muscle strengthening
  • Restoring the strength of the muscles of the ankle and foot will not only help bolster the tendon but improve overall function and reduce the risk of future injury
  • Eccentric strength training has especially been shown to have positive effects on chronic Achilles tendon pain
  1. Ultrasound
  • Improves blood flow, reducing Achille’s tendon pain and enhancing function.
  • The sound waves are converted into heat within the tissue, opening up blood vessels and facilitating repair of the injured tissue.

  1. Wobble Board Training
  • Improves balance stimulating proprioception and neuromuscular control

Our take home message is that prolonged or excessive pronation can cause Achilles tendon pain and that Physiotherapy management can improve function and pain.