Understanding Midportion Achilles Tendinopathy

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Achilles tendinopathy is particularly prevalent especially amongst runners. But it is not uncommon to find them amongst people who don’t participate in sports. Amongst people who play sports, about 11% suffer from this overuse injury. If you suffer from mid-portion achilles tendinopathy, then eccentric exercises are for you. If you are runner, the achilles tendon plays a major part in your overall performance (see Running Economy).

What’s The Midportion?

The Achilles tendon is the tendon that starts off from your calf muscle and connects to your heel bone in your foot. It blends in to what is called your plantar fasciitis (the thick sinewy materials that forms the arch of your foot). The midportion of your Achilles tendon is the area approximately 2-6cm from the end that connects your heel bone. This areas is has relatively little blood supply compared to the other two ends. It is believed that this poor blood supply is one of the reasons why this area is prone to injury.

The Differential Diagnosis

If you are a regular reader of this site, you will know that getting the diagnosis is a key element in the treatment plan. So the first step is to us to distinguish midportion tendinopathy from other conditions with similar symptoms. Other conditions that have similar symptoms around the region are:

  • Insertional Achilles Tendinopathy
  • Tendon rupture (this can be ruled out with calf squeeze test)
  • Paratentonitis
  • Retrocalcaneal bursitis (shows up as a prominent warm area of the upper back part of the heel) [/when-is-achilles-tendonitis-not-achilles-tendonitis-when-it-is-retrocalcaneal-bursitis/]
  • Retro-Achilles bursitis (pain is near the skin surface and the area back of the heel is warm)

Patients With Achilles Tendinopathy Usually Experience:

  • morning stiffness of the calf muscles
  • pain at the start of exercise and immediately after training
  • heat, grating sound and increased skin redness around the tendon
  • pain even at rest in chronic stages

How Does Someone Get Achilles Tendinopathy?

People who suffer from achilles tendinopathy usually get it as a result of a rapid increase in running mileage. Either that, or changes to running on sloping, hard or slippery roads which can contribute to tendon overload.

Among athletes, biomechanical factors including a foot joint that is too loose and flexible, or too stiff [excessive pronation of the foot joint (subtalar joint), limited passive dorsiflexion or subtalar joint mobility[, and leg length discrepancy have been considered predisposing factors for Achilles tendon injuries.

Eccentric Ankle Exercises

Eccentric exercises during a 12 week program showed 60-90% positive results in decreasing pain in several randomized controlled trials. This evidence, combined with their low cost and low risk, makes these exercises ideal first-line therapy (Magnussen, Dunn & Thomson 2009). Eccentric exercises are where the muscles lengthen under tension (or load).


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Magnussen, RA, Dunn, WR & Thomson, AB 2009,´ Nonoperative Treatment of Midportion Achilles Tendinopathy: A Systematic Review`, Clincal Journal of Sport Medicine, vol.19, no.1, pp. 54-64.