Shockwave Therapy for Achilles Tendinopathy

The Achilles tendon is a tough band of fibrous tissue that transmits load from the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus), making it possible to flex the foot (plantarflexion). Achilles tendinopathy is typically an overuse injury associated with repetitive plantarflexion, which is commonly seen in runners and jumpers.

The two main types of Achilles tendinopathy are:

  1. Insertional – up to 2cm from the Achilles tendon insertion to the calcaneus.
  2. Non-insertional – mid portion is affected (2-6cm from the insertion of the Achilles tendon into the calcaneus).

Signs and symptoms:

  • Pain, stiffness, possible swelling local to the Achilles tendon
  • Gradual onset
  • Pain may be worse in the morning
  • Pain may be aggravated by activity requiring plantarflexion (eg. running) and may be eased by rest

Contributing factors:

  • Footwear
  • Hill running
  • Increase in training distance/frequency/pace
  • Biomechanical abnormalities – eg.  “flat feet” (hyperpronation)
  • Obesity/increased BMI


  • Load management
  • Eccentric loading exercises
  • Orthotics/footwear advice
  • Addressing contributing factors (eg. biomechanics, running pattern)
  • Shockwave therapy
  1. – Moderate evidence for ESWT alone, strong evidence supporting the use of ESWT for chronic Achilles tendinopathy in addition to a progressive load management program (Mani-Babu et al. 2014; Mallearis 2016)
  2. – In a 2019 study, 64% of patients with chronic insertional Achilles tendinopathy had complete recovery or significant improvement in symptoms after 3 sessions of ESWT (Stania et al. 2019).
  3. – Significant reduction in pain and function, as measured by the American Orthopaedic Foot and Ankle Score (AOFAS), in Achilles tendinopathy patients in response to ESWT compared to placebo (Vahdatpour et al. 2018).

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