Midportion Achilles Tendinopathy


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What is the Achilles Tendon?

The Achilles is the tendon that attaches the muscles of the gastrocneumius (calf) and soleus to the back of the calcaneus (heel).

Its main role is to plantarflex the ankle (pointing the foot down) and is responsible for providing most of the force at push off.

What is Midportion Achilles Tendinopathy?

Midportion Achilles Tendinopathy is a chronic overuse injury of the midportion of the Achilles Tendon (the midportion of the Achilles is located 2-3cm above the heel)

People with this problem generally present with pain when first getting out of bed which reduces slightly after walking a short distance and then returns again with extended walking.

It is also a common feature that there may be a nodule in the middle of the Achilles  tendon- this occurs when there is a fat build up within the tendon and will present as a palpable nodule

Causes of Midportion Achilles Tendinopathy

The Achilles Tendon is made up of collagen fibres which are similar to a rope.

Mid portion Achilles tendinopathy involves chronic degeneration at the mid portion of the Achilles tendon.

Click for more in depth information on the pathophysiology of Midportion Achilles Tendinopathy

Certain factors are though to increase the risk for the development of Midportion Achilles Tendinopathy including:

  • Certain medications (Fluoroquinolones – ciprofloxacin)
  • Non- Supportive footwear
  • Flat arched feet
  • High arched feet
  • Sudden increase in activity
  • Trauma
  • Being overweight
  • Hormone problems (Reduced Thyroid function, Menopause)
  • Connective tissue disorders (Rheumatoid arthritis)

Diagnosis of Midportion Achilles Tendinopathy

Diagnosis is generally made with specific signs and symptoms – when the pain occurs and the location.

At the Ankle, Foot and Orthotic Centre we are able to provide additional information about the presence of Midportion Achilles Tendinopathy with ultrasound imaging.

Typically someone with midportion Achilles will have a thicker disorganised midportion area in the midportion of the Achilles shown in the picture below.

This is in addition to extra blood vessels in the tendon as shown below.

Thick Achilles Tendon Vascular Ultrasound

Treatment of Midportion Achilles Tendinopathy

Treatment aims to reduce the disorganisation of the connective tissue in the Achilles tendon and also minimise the risk factors for re-injury. This can include


What else could it be? (differential diagnosis)

Other problems that can cause similar pain to a neuroma include:

Retrocalcaneal bursitis

Kagers Fat Pad Inflammation

Tarsal Tunnel Syndrome

Tibialis posterior tendon dysfunction



The Ankle, Foot and Orthotic Centre’s Northcote Podiatrists can help you with all lower limb complaints, including Achilles pain. Make an appointment to get your foot and ankle pain under control.

Expert Podiatrists and Orthotists in the treatment of Achilles problems servicing the areas of Northcote, Thornbury, Fitzroy, North Fitzroy, Carlton, North Carlton, Alphington, Fairfield, Brunswick, Coburg and Preston

Call The Ankle, Foot and Orthotic Centre in Northcote for further advice on professional management and treatment options.