What is achilles tendinitis?
Achilles tendinitis is irritation of the Achilles tendon — the thick band that connects your calf muscles to your heel. Modern thinking calls it 'tendinopathy' since most cases involve degenerative changes in the tendon, not just inflammation. It typically presents as pain and stiffness at the back of the ankle, especially in the morning or starting activity. There are two main types: insertional (where the tendon meets the heel bone) and mid-portion (2–6 cm above the heel) — they're treated slightly differently. The most effective treatment is progressive tendon loading, not rest.
Common symptoms
- Pain and stiffness at the back of the ankle, worst in the morning
- Pain that 'warms up' with activity then returns afterward
- Tenderness when squeezing the tendon
- Visible thickening or a small lump in the tendon
- Pain with calf raises or jumping
- Stiffness after sitting for a while
- Pain that builds gradually over weeks or months (not from a single injury)
- Feeling like the tendon needs to 'stretch out' before activity
What causes achilles tendinitis?
Achilles tendinopathy is typically an overuse injury — the tendon is loaded more than it can adapt to. Common contributors include sudden increases in running mileage or intensity, hill running or sprinting, weak calf muscles, tight ankle mobility, switching to low-drop shoes, and starting a new sport or activity. Age and genetics play a role too — tendons get stiffer and slower to recover after 40. Less commonly, certain antibiotics (fluoroquinolones) and some metabolic conditions increase risk.
How online PT helps with achilles tendinitis
Evaluation. Your first visit is an evaluation over video. Your PT identifies which type of tendinopathy you have (insertional vs mid-portion — they need different loading approaches), tests calf strength and ankle mobility, asks about your training history, and screens for other issues that can mimic Achilles pain.
Treatment. The cornerstone is progressive tendon loading — typically heavy, slow calf raise variations done daily or near-daily for 12+ weeks. Insertional cases avoid full ankle dorsiflexion stretching; mid-portion cases tolerate eccentric drops off a step. You'll also work on calf flexibility, ankle mobility, and addressing the training overload that caused the issue in the first place. Some short-term load modification helps, but full rest usually delays recovery.
Ongoing support. Tendon recovery is slow — most patients see meaningful improvement within 8–12 weeks but full resolution often takes 4–6 months of consistent loading. Message your PT between visits about pain levels (some pain during/after exercise is okay), progressions, and training questions.
What to expect
Your first visit is about 60 minutes over video. Your PT identifies the type of tendinopathy, tests strength and mobility, and starts you on a structured loading program. Recovery requires patience — tendons adapt slowly. Most patients see meaningful improvement within 8–12 weeks, with full recovery in 4–6 months. The key is consistency: daily loading work, gradual training return, and not abandoning the program when symptoms initially improve.
Insurance accepted for achilles tendinitis
Online physical therapy for achilles tendinitis is covered by most major insurance plans. You pay your normal copay — nothing extra for online visits.
MedicareBlue Shield of CaliforniaAnthem Blue CrossCignaAetnaUnited HealthcareHumana
Don't see your plan? Check your coverage — we accept many more.