Upper Achilles pain? Causes and treatment for high Achilles tendonitis

Struggling with pain at the top of your Achilles tendon? Learn what causes this type of pain, how to identify it, and the most effective treatment steps to get you back to pain-free movement.

Remember, if you need help with an Achilles injury, you're welcome to consult one of our team via video call.

The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.

In this article:

1. Anatomy overview

2. Causes of upper Achilles pain

3. Symptoms of upper Achilles tendonitis

4. Treatment approach for high Achilles tendonitis

5. How we can help

We've also made a video about this:

Anatomy overview

The high Achilles refers to the section where the calf muscle blends into the Achilles tendon. This area is higher up the back of the lower leg than many people expect.

The Achilles tendon itself starts at the back of the heel and runs upwards. Eventually, it transitions into the calf muscles at a point called the musculotendinous junction. This is where force from the calf muscles is transferred into the tendon, enabling the powerful push-off movement when you walk, run, or jump.

High Achilles tendonitis isn’t very common. Most Achilles tendon problems occur lower down – either in the mid-portion of the tendon or at its insertion into the heel bone.

Causes of upper Achilles pain

Upper Achilles tendonitis or tendinopathy usually develops gradually rather than from a sudden accident or injury. It’s most often linked to overuse, which happens when there’s been a sudden change or increase in activity levels.

Common scenarios include:

• Returning to sport after a break, illness, or holiday.

• Rapidly increasing training frequency, speed, or intensity – for example, jumping from a few weekly sessions to daily workouts, or suddenly adding sprint sessions.

• A change in footwear, such as wearing loose sandals or flip-flops in summer, or boots (like rubber boots for wet conditions) that don’t fit snugly.

Symptoms of upper Achilles tendonitis

Typical symptoms include:

• Pain or tenderness when pressing on the high Achilles area compared to the other leg.

• Stiffness and tightness first thing in the morning or after being still for a while, such as after sitting in a car.

• Pain when you first start exercising, which may ease as you warm up, or pain that appears later during or after activity.

It’s important to distinguish this type of pain from other issues:

• Calf tear or Achilles rupture: These usually cause sudden, sharp pain, often with bruising, swelling, or an audible snap or pop. They are also linked to an immediate loss of strength, such as being unable to rise onto tiptoes.

• Referred pain from nerves in the back: Sometimes, irritation in the lower spine can send pain into the back of the calf. A physiotherapist might carry out specific tests, such as the slump test, to check whether nerve tension could be contributing to the symptoms. We also use the slump test as part of our Video Assessments – I demo it here.  

👉 Most cases of high Achilles tendonitis don’t require scans or X-rays. Imaging is only considered if there’s a strong suspicion of a tear or another underlying problem.

Treatment approach for high Achilles tendonitis

The treatment approach for upper Achilles tendonitis is similar to that of mid-portion injuries and involves a two-pronged approach.

1. Calming the irritation

The first step is to reduce stress on the tendon by identifying and adjusting the activities that trigger symptoms.

• You might need to temporarily reduce your training load, such as lowering your step count or replacing some running sessions with walking or jogging.

• Avoiding sprint sessions or cutting down the number of weekly workouts can also help.

• Reviewing footwear choices can make a difference, especially if you’ve recently changed shoes.

^💡 Remember, symptoms don’t always appear immediately during activity. Sometimes pain flares up later the same day or even the following day, so it’s important to monitor how your Achilles feels over a 24-hour period.

2. Building strength and resilience

Once the tendon has calmed, the focus shifts to progressively strengthening the Achilles–calf unit. A stronger tendon and muscle complex can handle more load without becoming irritated.

The exact starting point for exercises will depend on your current ability and comfort level. Examples include:

• Isometric holds: Rising onto your toes and holding without movement.

• Controlled calf raises: Using bodyweight and both legs at first, then gradually progressing to single-leg exercises and adding weights.

• Advanced exercises: Once basic strength is regained, plyometric activities such as hopping or jumping can be added for those returning to higher-level sports. This step can usually be skipped if your goals are just to walk or do low-impact activities.

Your rehab exercises must match your tendon’s current strength and sensitivity – doing too much too soon can make your pain worse.

Everyone will start at a different level, and the exercises that are included in their plan will depend on their tendon’s current sensitivity, its current strength, and the types of activity they want to be doing. Maryke discusses the different types of exercise for Achilles tendonitis in detail here.

The key is slow, steady progression. Building strength over time helps the tendon to adapt, allowing you to return to normal activities with less pain and reduced risk of recurrence.

There are other treatments that can be useful for pain relief and stubborn cases, which we discuss in our research-based treatments review article.

How we can help

Every case of upper Achilles tendonitis is unique, and recovery is much faster with a tailored plan. Our expert physiotherapists at Treat My Achilles specialise in online consultations, providing a clear diagnosis and a customised treatment programme you can follow at home.

If you’re struggling with persistent pain or unsure how to safely return to your sport, book an online appointment today to get professional guidance and start your recovery with confidence.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. All of us have a wealth of experience working with athletes across a broad variety of sports and ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Alison Gould is a chartered physiotherapist and holds an MSc in Sports and Exercise Medicine. You can follow her on LinkedIn, Facebook, Instagram, and Twitter.

References

1. Khan, Karim M. B.Med.Sci, M.B.B.S.; Maffulli, Nicola M.D., M.S., Ph.D. Tendinopathy: An Achilles' Heel for Athletes and Clinicians. Clinical Journal of Sport Medicine 8(3):p 151-154, July 1998.

2. Maffulli N, Sharma P, Luscombe KL. Achilles tendinopathy: aetiology and management. J R Soc Med. 2004 Oct;97(10):472-6.

3. J. D. Rees, A. M. Wilson, R. L. Wolman, Current concepts in the management of tendon disorders, Rheumatology, Volume 45, Issue 5, May 2006, Pages 508–521.

4. Tong S, Sun Y, Kuang B, Wang M, Chen Z, Zhang W, Chen J. A Comprehensive Review of Muscle-Tendon Junction: Structure, Function, Injury and Repair. Biomedicines. 2024 Feb 12;12(2):423.

5. Webborn, N. and Webborn, N.A., 2007. Neuropathic model to the etiology and management of Achilles tendinopathy. Tendinopathy in athletes. Oxford: Blackwell Publishing, pp.145-59.