Achilles tendon pain during pregnancy is pain or stiffness in the tendon that joins the calf muscles to the heel bone. Pregnancy can change body weight, balance, walking pattern and activity load, but current evidence does not show that hormones alone directly cause Achilles tendinopathy.
Pain at the back of the heel still needs an individual assessment. Achilles tendinopathy is one possible cause, but heel bursitis, a calf injury, a tendon tear and a blood clot can produce different symptoms and require different care.
Symptoms of Achilles tendon pain during pregnancy
Achilles tendon pain usually affects the back of the ankle or the area just above the heel. Symptoms may include:
- Pain or tenderness in the tendon during walking, running, climbing stairs or rising onto your toes.
- Stiffness after rest or on the first few steps in the morning.
- Swelling or thickening around the tendon.
- Reduced calf strength or difficulty pushing off through the foot.
Causes of Achilles tendon pain during pregnancy
Achilles tendon pain develops when the load placed on the tendon exceeds its current capacity. Pregnancy may change that balance through several interacting factors rather than one hormone or one stage of pregnancy.
- Changes in body weight and balance: A changing centre of gravity can alter how force moves through the foot and ankle during standing, walking and exercise.
- Changes in activity: A sudden increase or decrease in training, followed by a rapid return to activity, can change the amount of load the tendon can tolerate.
- Calf weakness or reduced endurance: The calf muscles and Achilles tendon work together to control the ankle and create push-off during walking and running.
- Footwear and foot posture: Less supportive footwear, prolonged standing or changes in foot posture may increase symptoms in some people.
- Previous tendon pain: A history of Achilles tendinopathy may increase the chance of symptoms returning when activity or loading changes.
Pregnancy hormones affect several tissues in the body, but their specific effect on the Achilles tendon is not established. A 2026 study comparing pregnant women across the three trimesters found no significant difference in measured Achilles tendon tissue properties. Hormonal change should therefore not be presented as the sole explanation for Achilles pain.
When to see a physiotherapist or doctor for Achilles tendon pain during pregnancy
A physiotherapist can assess pain that persists, limits walking or affects exercise. Contact a doctor promptly if the ankle becomes very swollen, red or hot, or if you cannot bear weight.
Seek urgent medical care if you feel a sudden snap or pop and cannot push off through the foot, as this may indicate an Achilles tendon rupture. Sudden calf pain, swelling, warmth or shortness of breath needs urgent medical assessment because pregnancy increases the risk of a blood clot. Call 995 for chest pain, severe breathlessness or collapse.
Stop exercising and contact your maternity care team if you have vaginal bleeding, fluid loss, painful contractions, severe abdominal pain, dizziness, chest pain, calf pain or reduced fetal movement.
Assessment of Achilles tendon pain during pregnancy
The assessment begins with the location and pattern of your pain, your pregnancy stage, your activity level and any previous tendon problems. The physiotherapist may examine ankle movement, calf strength, balance, walking and the tendon response to gradual loading.
Imaging is not routinely needed when the clinical findings are clear. A doctor may arrange ultrasound or other imaging if symptoms suggest a tear, fracture or another condition. Imaging decisions during pregnancy should be discussed with your medical and maternity care teams.
Physiotherapy treatment for Achilles tendon pain during pregnancy
Tendon-loading exercise is first-line care for midportion Achilles tendinopathy in the general adult population. During pregnancy, the exercise programme should also account for obstetric health, balance, fatigue, exercise history and the way symptoms respond during the following 24 hours.
A physiotherapy plan may include:
- Load management: Reduce or temporarily replace the activities that cause a marked increase in pain, while maintaining comfortable activity where possible.
- Progressive calf exercise: Begin with a tolerable variation, such as seated calf raises or supported standing calf raises, then increase resistance gradually.
- Strength and balance training: Pregnancy-appropriate exercises for the calf, hip and trunk may support walking, balance and general conditioning.
- Footwear advice: Supportive footwear or a temporary heel lift may reduce tendon strain for some people, but these measures should support rather than replace progressive exercise.
- Return to activity: Walking, running and sport can be increased in stages according to pain, strength, function and obstetric guidance.
Complete rest is not usually required for tendinopathy. Sharp pain, increasing swelling, a change in walking pattern or symptoms that remain substantially worse the next day indicate that the current exercise load may be too high.
Treatment modalities for Achilles tendon pain during pregnancy
Exercise and load management remain the main components of Achilles tendinopathy rehabilitation. Pregnancy-specific evidence for shockwave therapy, therapeutic radiofrequency and dry needling for Achilles tendon pain is limited, so these modalities should not be presented as routine care or as ways to accelerate healing.
- Shockwave therapy: Shockwave therapy is used for some non-pregnant adults with persistent tendinopathy. Pregnancy is commonly listed as a contraindication or precaution, and the fetus must not be in the treatment field. HelloPhysio does not present shockwave therapy as routine treatment for Achilles pain during pregnancy.
- Therapeutic radiofrequency: Evidence for radiofrequency therapy in Achilles tendinopathy is limited, and pregnancy-specific evidence is insufficient. Treatment that could expose the fetus to radiofrequency energy should be avoided. Any proposed use requires the device instructions, the application site and the advice of the maternity care team to be considered.
- Dry needling: Evidence for dry needling during pregnancy is limited and does not establish a direct benefit for pregnancy-related Achilles pain. A recent clinical consensus lists the first trimester and high-risk pregnancy as contraindications. Dry needling is not a first-line treatment for Achilles tendinopathy.
- Clinical Pilates: Modified clinical Pilates may support general strength, balance and movement control during an uncomplicated pregnancy. It has not been shown to repair the Achilles tendon directly and should be adapted to the individual and pregnancy stage.
Discuss new exercise or modality-based care with your obstetrician when you have a high-risk pregnancy, a medical condition or pregnancy-related complications.
Self-care for Achilles tendon pain during pregnancy
Simple steps can help you manage tendon load while you arrange an assessment:
- Wear comfortable, supportive footwear for walking and prolonged standing.
- Replace painful running or jumping temporarily with a comfortable low-impact activity, such as swimming or a stationary bicycle, if your maternity care team considers it suitable.
- Avoid aggressive calf stretching if it increases pain at the back of the heel.
- Record which activities increase symptoms and how the tendon feels the next morning.
- Do not start pain medicines or anti-inflammatory medicines during pregnancy without checking with a doctor or pharmacist.
Preparing for your physiotherapy appointment
Bring details of your pregnancy stage, current exercise, recent changes in walking or training, previous Achilles problems and any advice from your obstetrician. Tell the physiotherapist about swelling, night pain, calf symptoms, medicines and pregnancy complications.
Care at HelloPhysio
HelloPhysio assesses the tendon, calf strength, ankle movement, balance and activity load before recommending pregnancy-appropriate rehabilitation. The plan can be coordinated with your obstetrician or maternity care team when medical or pregnancy factors affect exercise.
To discuss Achilles tendon pain during pregnancy, you can book an assessment with a physiotherapist.
Frequently asked questions about Achilles tendon pain during pregnancy
Can pregnancy hormones cause Achilles tendon pain?
Pregnancy hormones affect the body, but current evidence does not establish that hormones alone cause Achilles tendinopathy. Changes in loading, body weight, balance, activity, strength and footwear may all contribute.
Can I continue walking or exercising with Achilles pain during pregnancy?
Many people can continue comfortable activity with suitable modification. Reduce activities that cause a marked increase in pain, and ask your obstetrician and physiotherapist how to adapt exercise to your pregnancy and symptoms.
Is shockwave therapy suitable during pregnancy?
Pregnancy is commonly listed as a contraindication or precaution for shockwave therapy, and the fetus must not be in the treatment field. Shockwave therapy should not be presented as routine care for Achilles tendon pain during pregnancy.
References
- Academy of Orthopaedic Physical Therapy. Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendinopathy Revision 2024. Journal of Orthopaedic and Sports Physical Therapy. 2024;54(12):CPG1-CPG32.
- American College of Obstetricians and Gynecologists. Physical Activity and Exercise During Pregnancy and the Postpartum Period. Committee Opinion No. 804.
- HealthHub Singapore. Being Fit When Pregnant.
- KK Women’s and Children’s Hospital. HELMS Model of Care: Pregnancy, Joint Pain.
- Kablan N, Varol F, Kalan MC, et al. Differential changes in plantar fascia and Achilles tendon tissue properties between pregnancy trimesters. Journal of Back and Musculoskeletal Rehabilitation. 2026.
- International Society for Medical Shockwave Treatment. Guidelines for Extracorporeal Shock Wave Therapy. 2024.
- Treatment Guidelines and Decision Tree for Dry Needling Musculoskeletal Conditions: A Consensus Statement. International Journal of Sports Physical Therapy. 2026.
Reviewed by Jenny Huang, Senior Physiotherapist
Last reviewed: 9 November 2026
