Achilles Tendon Pain When Walking or Running: Common Causes and When to Get It Checked
Pain at the back of the ankle or just above the heel is commonly caused by the Achilles tendon.
You may notice pain when:
- Walking
- Running
- Climbing stairs
- Sprinting
- Jumping
- Standing on tiptoe
- Taking your first few steps in the morning
- Returning to exercise after a period of inactivity
The Achilles tendon connects the calf muscles to the heel bone and is heavily loaded whenever you walk, run, jump or push off through the foot. Achilles tendon problems often develop after a sudden increase in activity or repeated overloading.
What Is Achilles Tendinopathy?
Achilles tendinopathy describes a painful problem affecting the Achilles tendon.
It may occur:
- In the middle portion of the tendon
- Where the tendon attaches to the heel
Mayo Clinic notes that symptoms commonly begin as an ache behind the lower leg or above the heel after running or sport and may progress to pain with prolonged running, stair climbing or sprinting.
What Does Achilles Tendon Pain Feel Like?
Common symptoms include:
- Pain above the heel
- Tenderness along the tendon
- Morning stiffness
- Pain during or after exercise
- Pain climbing stairs
- Swelling or thickening of the tendon
- Reduced push-off strength
Some people notice that the first few steps after sitting or getting out of bed are particularly uncomfortable, then symptoms temporarily improve after moving.
Why Does My Achilles Hurt When I Walk?
Walking repeatedly loads the Achilles tendon as the calf muscles push the body forward.
If the tendon has become irritated or has lost some of its ability to tolerate load, even normal walking can become painful.
Possible contributing factors include:
- Sudden increase in walking distance
- Starting a new exercise programme
- Hill walking
- Tight calf muscles
- Returning to sport too quickly
- Previous Achilles problems
Mayo Clinic notes that abrupt increases in walking or running, hills and activities involving sprinting or jumping can contribute to Achilles symptoms.
Why Does My Achilles Hurt When Running?
Running places substantially greater load through the tendon than ordinary walking.
Problems commonly appear when someone suddenly:
- Runs farther
- Runs faster
- Adds hills
- Starts sprinting
- Returns to running after a long break
A tendon may tolerate your previous training level but react when the workload rises faster than it can adapt.
Why Is the Achilles Stiff in the Morning?
Morning stiffness is common with Achilles tendinopathy.
After several hours of relative inactivity overnight, the tendon may initially feel stiff and painful.
Mayo Clinic lists morning tenderness and stiffness as characteristic symptoms.
Can Achilles Pain Improve After I Start Walking?
Yes.
A common pattern is:
- Pain during the first few steps
- Some improvement after warming up
- Pain returning after prolonged walking or exercise
Temporary improvement while moving does not necessarily mean the tendon has recovered.
Could My Achilles Tendon Be Torn?
Possibly, particularly if the pain started suddenly.
A rupture is more concerning when you experience:
- A sudden sharp pain
- A snapping or popping sensation
- The feeling that someone kicked you from behind
- Sudden weakness
- Difficulty pushing off
- Difficulty standing on tiptoe
- Major difficulty walking
Mayo Clinic advises urgent medical assessment for suddenly severe Achilles pain or pain that prevents normal movement because a tendon tear may have occurred.
Achilles Tendinopathy vs Achilles Rupture
A gradual-onset tendon problem and a sudden tear usually have different patterns.
Achilles Tendinopathy
More commonly:
- Develops gradually
- Is related to repeated loading
- Produces stiffness and aching
- May improve temporarily after warming up
Achilles Rupture
More commonly:
- Happens suddenly
- Produces major weakness
- Causes difficulty pushing off
- May be associated with a pop or snap
A partial tear can sometimes be harder to distinguish clinically, so persistent or unusual weakness deserves assessment.
Should I Stop Walking or Running?
Not necessarily, but the load may need to be reduced.
For example, temporarily reduce:
- Long-distance walking
- Running
- Hills
- Sprinting
- Jumping
Complete prolonged rest can also reduce tendon strength.
For persistent Achilles tendinopathy, rehabilitation usually aims to gradually rebuild the tendon’s ability to tolerate load rather than avoiding activity permanently.
Can Physiotherapy Help?
Yes.
Exercise-based rehabilitation is one of the main treatments for Achilles tendinopathy.
Mayo Clinic notes that resistance exercises, including progressively loaded heel raises, can be particularly useful in chronic Achilles tendon problems.
A programme may include:
- Calf strengthening
- Progressive heel raises
- Ankle mobility
- Gradual return to walking or running
- Modification of training load
Should I Stretch My Achilles?
Gentle mobility work may be useful in selected patients.
However, aggressive stretching is not always appropriate, particularly when pain is located directly at the heel attachment.
The treatment should match the exact location and type of tendon problem.
What if Physiotherapy Is Not Helping?
If symptoms remain significant despite an appropriate rehabilitation programme, reassessment may be useful.
Questions include:
- Is this definitely Achilles tendinopathy?
- Is there a partial tear?
- Is another ankle structure causing the pain?
- Is the exercise load appropriate?
- Would ultrasound or MRI change treatment?
Persistent symptoms do not automatically mean surgery is required.
Is Shockwave Therapy Used for Achilles Tendon Pain?
Yes, in selected chronic cases.
Mayo Clinic describes extracorporeal shockwave therapy as a non-invasive treatment that may be used when simpler measures have not worked, typically before considering surgery.
It does not replace progressive rehabilitation.
The goal is usually to combine symptom improvement with restoring tendon strength and function.
What About PRP?
Platelet-rich plasma has also been used for Achilles tendon problems.
Mayo Clinic lists PRP among newer treatments used in selected cases.
However, not every patient needs an injection or procedure.
The first step is to establish the diagnosis and whether rehabilitation has been adequately progressed.
Should I Get an X-Ray?
An X-ray does not show the Achilles tendon itself in detail.
It may be useful to assess:
- Heel bone abnormalities
- Calcification
- Other bone-related causes
Mayo Clinic notes that X-rays may help rule out other conditions even though they do not show soft tissues such as tendons well.
Is Ultrasound Useful for Achilles Tendon Pain?
Yes.
Ultrasound can assess:
- Tendon thickness
- Tendon structure
- Tendinopathy
- Partial tears
- Complete tears
It can also show the tendon moving in real time.
Mayo Clinic notes that ultrasound can image the Achilles tendon dynamically, while RadiologyInfo specifically lists Achilles tendinitis and Achilles tendon tears among common uses of musculoskeletal ultrasound.
Does Ultrasound Use Radiation?
No.
Ultrasound uses sound waves and does not use ionising radiation.
When Is MRI Useful?
MRI can show the Achilles tendon and surrounding structures in considerable detail.
Mayo Clinic notes that MRI uses a strong magnetic field and radio waves to show the Achilles tendon in detail.
MRI may be useful when:
- Symptoms remain unexplained
- A significant tear is suspected
- Ultrasound findings are unclear
- There may be additional ankle pathology
- Symptoms persist despite treatment
- Surgery is being considered
Ultrasound vs MRI for Achilles Tendon Pain
Both can be useful.
Ultrasound May Be Particularly Useful For:
- Achilles tendinopathy
- Tendon thickening
- Partial tears
- Dynamic tendon assessment
- Focused superficial evaluation
MRI May Be Particularly Useful For:
- More comprehensive ankle assessment
- Deeper structural injury
- Extent of tendon damage
- Multiple possible causes
- Pre-surgical assessment
The best test depends on the clinical question.
Does Achilles MRI Use Radiation?
No.
MRI does not use ionising radiation. Musculoskeletal MRI uses a magnetic field and radio waves to create detailed images of soft tissue and bone.
Does Everyone With Achilles Pain Need a Scan?
No.
Typical Achilles tendinopathy can often be diagnosed from:
- Symptoms
- Pain location
- Examination
- Strength testing
- Tendon tenderness
Imaging becomes more useful when:
- Symptoms are persistent
- Weakness is significant
- A tear is suspected
- The diagnosis is uncertain
- Treatment is not working
What if the Pain Is Right at the Heel?
Pain where the tendon attaches to the heel is sometimes called insertional Achilles tendinopathy.
This differs slightly from pain located several centimetres above the heel.
The exercise and loading strategy may therefore need to be modified according to where the tendon is painful.
What if My Achilles Is Swollen or Thickened?
Chronic Achilles tendinopathy can cause:
- Thickening
- Tenderness
- Local swelling
However, sudden major swelling following an acute injury raises greater concern about a tear or another acute injury.
What if I Cannot Stand on Tiptoe?
Difficulty standing on tiptoe can indicate reduced calf and Achilles function.
If this occurs suddenly after an injury, particularly with:
- A pop
- Sudden pain
- Major weakness
seek prompt medical assessment.
What if My Calf Feels Weak?
Some weakness can develop simply because you have reduced activity due to pain.
However, significant weakness deserves assessment because the Achilles tendon is responsible for transmitting calf-muscle force to the foot.
When Should I See a Doctor?
Arrange an assessment if:
- Achilles pain persists
- Walking remains painful
- Morning stiffness is worsening
- You cannot return to running or sport
- Physiotherapy has not helped
- The tendon remains swollen or weak
Mayo Clinic advises medical review when Achilles pain does not go away.
When Is Achilles Pain Urgent?
Seek prompt medical attention if:
- Pain began suddenly and severely
- You felt or heard a pop
- You suddenly cannot push off normally
- You cannot stand on tiptoe
- Walking becomes very difficult
These symptoms may indicate an Achilles tendon rupture.
How Much Does an Ankle MRI Cost in Singapore?
For many patients arranging an ankle MRI through The Pain Relief Clinic, the current price is approximately:
S$1,000
This generally includes:
- MRI examination
- MRI images
- Formal radiologist’s report
Eligible outpatient diagnostic scans may qualify for up to:
S$600 per patient per year from MediSave
subject to prevailing requirements and remaining annual limits.
Singapore’s Ministry of Health confirms that the annual MediSave withdrawal limit for eligible outpatient CT and MRI scans increased from S$300 to S$600 from 1 January 2026.
How Quickly Can I Get an Ankle MRI?
When MRI is medically appropriate, The Pain Relief Clinic can often arrange ankle imaging:
Within one working day
subject to:
- MRI safety screening
- Appropriate imaging protocol
- Appointment availability
Frequently Asked Questions About Achilles Tendon Pain
Why does my Achilles hurt when I walk?
The Achilles tendon is heavily loaded during walking. Tendinopathy may make the tendon painful when repeatedly loaded.
Why does my Achilles hurt after running?
Running increases the force through the tendon. Symptoms often develop after sudden increases in distance, speed, hills or intensity.
Why is my Achilles stiff in the morning?
Morning stiffness is a common feature of Achilles tendinopathy.
How do I know if I tore my Achilles?
Sudden severe pain, a pop, major weakness, inability to push off normally or difficulty standing on tiptoe are concerning signs.
Is ultrasound good for Achilles tendon problems?
Yes. Ultrasound can assess Achilles tendinopathy and tendon tears and can show the tendon dynamically.
Do I need an MRI?
Not automatically. MRI becomes more useful when the diagnosis is uncertain, a significant tear is suspected or symptoms remain persistent despite treatment.
Does MRI use radiation?
No. MRI does not use ionising radiation.
Can shockwave therapy help?
Shockwave therapy may be considered for selected chronic Achilles tendon problems when simpler treatments have not provided sufficient improvement.
How much does an ankle MRI cost?
An ankle MRI arranged through The Pain Relief Clinic is currently approximately S$1,000, including scan images and a formal radiologist’s report.
Achilles Pain Making Walking or Running Difficult?
If pain at the back of the ankle is limiting walking, running, stairs or sport, it may be useful to determine whether the problem is:
- Achilles tendinopathy
- A partial tendon tear
- A more significant Achilles injury
- Another ankle condition
At The Pain Relief Clinic, we can assess:
- The exact location of Achilles pain
- Tendon tenderness and swelling
- Calf strength
- Ability to push off and stand on tiptoe
- Whether ultrasound, MRI, X-ray or no imaging is most appropriate
- Whether physiotherapy, shockwave therapy or another non-surgical treatment may be suitable
When MRI is medically indicated, ankle imaging can often be arranged within one working day.
Achilles tendon assessment through The Pain Relief Clinic
- Medical assessment by a licensed medical doctor
- In-house physiotherapy
- Assessment of tendon strength and function
- Shockwave therapy where clinically appropriate
- Fast access to imaging when indicated
- Ankle MRI often available within one working day
- Approximately S$1,000 for many ankle MRI examinations
- Up to S$600 MediSave for eligible outpatient diagnostic scans
- Formal radiologist’s report
- Non-surgical treatment options where appropriate
- Orthopaedic referral where appropriate
Arrange an Achilles Tendon Assessment
The Pain Relief Clinic
Call / WhatsApp: +65 9068 9605
If Achilles tendon pain is making it difficult to walk, run or exercise — particularly if symptoms have persisted despite physiotherapy — contact us for an assessment of whether the diagnosis, rehabilitation programme or imaging plan should be reconsidered.
References
- Mayo Clinic — Achilles Tendinitis: Symptoms and Causes.
- Mayo Clinic — Achilles Tendinitis: Diagnosis and Treatment.
- Mayo Clinic Orthopedics & Sports Medicine — Achilles Tendon.
- RadiologyInfo.org — Musculoskeletal Ultrasound.
- RadiologyInfo.org — Musculoskeletal MRI, reviewed 15 June 2026.
- Singapore Ministry of Health — Keeping Healthcare Affordable and Sustainable for All.
- Singapore Ministry of Health — Adequacy of S$600 Annual MediSave Withdrawal Limit for Outpatient CT and MRI Scans, 6 August 2026.
Important Medical Information
This article provides general educational information and does not replace an individual medical consultation.
Achilles pain can result from tendinopathy, tendon tearing or other ankle and heel conditions. Symptoms alone cannot determine whether a tear is present.
Imaging is not required for every case. The appropriate investigation depends on how symptoms started, examination findings, tendon strength, duration, treatment response and whether imaging would change management.
Seek prompt medical attention for sudden severe pain, a popping or snapping sensation, sudden major weakness, inability to push off normally or difficulty standing on tiptoe after an injury.
Reviewed by Dr Terence Tan, Founder of The Pain Relief Clinic — 18 September 2026
What To Expect When I Visit The Pain Relief Clinic
A typical visit will involve our doctor first understanding your medical history, concerns and previous experience with other pain treatments.
For patients who have consulted many people but have yet to receive a clear diagnosis, selecting an affordable imaging scan might be recommended to confirm the cause of your pain..
Some patients have already done scans with other doctors for their pain condition but are still not clearly told what they suffer from.
Dr Terence Tan is happy to offer you a second opinion and recommend how best to manage your condition.
We also see patients who already have a confirmed diagnosis from specialist pain doctors, but are "stuck” because treatment options offered are not practical or acceptable.
We can help by discussing options that you might have potentially never been told of.
A common experience is when a patient has already consulted a specialist doctor for pain management and is told to consider orthopaedic surgery which they find too aggressive.
Or they may have seen doctors for their pain and were prescribed painkillers with potential side effects which made them feel uncomfortable.
Many of our patients have also first tried complementary treatments or acupuncture with traditional Chinese pain doctors.
They look for a second opinion after finding any relief experienced from other treatments to be temporary or requiring repetitive treatments, which add up to time and cost.
Especially in such situations, we emphasize using non-invasive medical technology you likely have not been told about .
This can make a big difference to your results.
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For enquiries, Call +65 6732 2397
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