Achilles Tendon Injuries in Cyclists – What you need to know

If you are experiencing Achilles pain while cycling, it may be a condition called Achilles Peritendonitis (Abdullatif et al., 2021). This overuse injury involves the Achilles peritendon, which is the connective tissue sheath that surrounds the Achilles tendon. To visualise this, imagine pulling on a drawstring through a hoodie: the drawstring represents the rope like Achilles tendon, while the material tunnel it slides through represents the Achilles peritendon.

The Achilles peritendon plays a key role in allowing the tendon to glide smoothly without friction. However, with overload it can become irritated and cause symptoms.

How Does Achilles Peritendonitis Present?

• Diffuse pain and/or stiffness up and down the Achilles region
• Pain that often worsens throughout activity, such as cycling
• Tenderness to touch over the Achilles region
• Swelling and/or a crackling sensation may be present

What Might Cause Achilles Peritendonitis in Cyclists?

• Excessive movement of the ankle during cycling
• Poorly fitted cycling shoes: If your cycling shoes are too tight around the back of the heel, then this can cause compression over the Achilles
• Inadequate bike set up: An improper bike set up can lead to suboptimal pedalling biomechanics and potentially overload the Achilles peritendon
• Reduced ankle plantar flexion strength (Van Der Vlist et al., 2019): Strength deficits in the calf muscles may result in overload to the Achilles tendon sheath

How to Rehabilitate Achilles Peritendonitis?

A Physiotherapy assessment is recommended initially to confirm the diagnosis, as several other conditions can present with symptoms similar to Achilles peritendonitis (Malliaras et al., 2024). Exercise therapy is considered the first line treatment for managing Achilles tendon pain conditions like tendinopathy, aiming to reduce pain and improve function (Chimenti et al., 2025). Although Achilles Peritendonitis is different from other tendon overuse injury, its management typically follows similar principles. Therefore, treatment may include:

• Cycling load Management – Tempoarily reducing or modifying your ridinig volume and intensity can help with managing symptoms
• Footwear alterations – Adding a heel raise into the cycling shoe may be a helpful strategy to off load the achilles tendon (Chimenti et al., 2025)
• Calf muscle strengthening – While there’s limited research in cyclists with achilles injuries, evidence from other populations indicate that calf strengthening can reduce pain and improve function (Van Der Vlist et al., 2019). In the early stages of achilles peritendonitis, calf strengthening may be avoided if symptoms are provoked. However, once symptoms have subsided, then calf muscle exercises should be included, particularly targeting the soleus muscle
• Hip and quadriceps strengthening – Research indicates that people with Achilles tendinopathy have reduced hip and quadriceps strength (Sancho et al., 2022). Although research in cyclists is limited, improving hip and quadriceps strength may enhance load attenuation, and take stress away from the Achilles
• Bike Fit – A bike fit may be required to help optimise biomechanics and minimise excessive ankle range of motion throughout the pedal stroke. Talk to your Physiotherapist for tips and recommendations for professional bike fitters

• Written by Josie Pepper

  Josie Pepper is a physiotherapist with a Bachelor of Physiotherapy from Newcastle University and extensive experience in musculoskeletal care. She has a special interest in cycling, triathlon, and foot and ankle injuries and is currently completing a Master of Sports Physiotherapy at La Trobe University. A trained Clinical Pilates instructor with expertise in strength and conditioning, Josie is dedicated to helping patients achieve their rehabilitation goals through tailored exercise programs. Outside of work, she is a competitive road cyclist, riding for a Melbourne-based team.