Specialista in Ortopedia Pediatrica
Achilles tendon tightness
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Wall stretch (straight + bent knee)
Two different positions to stretch both calf muscles
POSITION 1 - GASTROCNEMIUS: Facing wall, leg to stretch behind with STRAIGHT knee, heel pressed down. Push hips forward. Hold 30 seconds. POSITION 2 - SOLEUS: Same position but now BEND the knee of back leg keeping heel down. This stretches deeper muscle (soleus). Heel must ALWAYS stay on ground in both positions.
3 × 30 seconds per position, each side. At least twice daily
2.Step stretch (eccentric)
More intense stretch, only if child is stable and coordinated
Stand on edge of step with front of foot on step, heels hanging off. ALWAYS hold railing or stable support. Slowly let heels drop below step level until feeling calf stretch. Don't bounce, hold position. CAUTION: requires good balance. If child is unsure, wall stretch is better.
3 × 30 seconds, always with secure support
3.Ankle mobility "knee to wall"
Test and exercise to improve ankle dorsiflexion
Place foot about 10 cm from wall (measure with ruler). Keeping heel firmly planted, bend knee forward trying to touch wall with kneecap. If easy, move foot 1 cm further and retry. If heel lifts, bring foot closer. Goal is to find maximum distance where you can touch wall without lifting heel. This is also a great test to monitor progress!
10-15 reps each side, slowly and controlled
4.Eccentric calf raises
Eccentric tendon strengthening - only for older children
On a step, hold railing. Rise onto toes with BOTH feet. Then transfer weight to ONE leg and SLOWLY LOWER (counting to 5) on that leg alone. The lowering phase is the important part! Rise again with both feet and repeat. NOTE: this is advanced, suitable for children over 8-10 with good coordination.
3 × 10 reps per leg. Only if indicated and supervised
5.Deep heel-down squat
Global mobilization to improve posterior chain flexibility
Squat as deeply as possible keeping BOTH heels on ground. Hold support if needed. If heels lift, place small raise (book, rolled towel) under heels and gradually work to reduce it. Stay in squat position breathing normally, trying to relax into position.
10 reps with 10-second pause at bottom, or hold 30-60 seconds
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
Versione Web
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MioDottoreBefore You Start
Who is this guide for?
Children with documented Achilles tendon tightness. Stretching is essential but must be consistent.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
3-4 times daily for stretching. Ideally after each prolonged rest period.
Common mistakes to avoid
- •Performing exercises too quickly without control
- •Pushing beyond the pain threshold
- •Skipping days or doing occasional very long sessions
- •Not warming up before strengthening exercises
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
Detailed Exercises
- 1
Wall stretch (straight + bent knee)
Two different positions to stretch both calf muscles
POSITION 1 - GASTROCNEMIUS: Facing wall, leg to stretch behind with STRAIGHT knee, heel pressed down. Push hips forward. Hold 30 seconds. POSITION 2 - SOLEUS: Same position but now BEND the knee of back leg keeping heel down. This stretches deeper muscle (soleus). Heel must ALWAYS stay on ground in both positions.
3 × 30 seconds per position, each side. At least twice daily - 2
Step stretch (eccentric)
More intense stretch, only if child is stable and coordinated
Stand on edge of step with front of foot on step, heels hanging off. ALWAYS hold railing or stable support. Slowly let heels drop below step level until feeling calf stretch. Don't bounce, hold position. CAUTION: requires good balance. If child is unsure, wall stretch is better.
3 × 30 seconds, always with secure support - 3
Ankle mobility "knee to wall"
Test and exercise to improve ankle dorsiflexion
Place foot about 10 cm from wall (measure with ruler). Keeping heel firmly planted, bend knee forward trying to touch wall with kneecap. If easy, move foot 1 cm further and retry. If heel lifts, bring foot closer. Goal is to find maximum distance where you can touch wall without lifting heel. This is also a great test to monitor progress!
10-15 reps each side, slowly and controlled - 4
Eccentric calf raises
Eccentric tendon strengthening - only for older children
On a step, hold railing. Rise onto toes with BOTH feet. Then transfer weight to ONE leg and SLOWLY LOWER (counting to 5) on that leg alone. The lowering phase is the important part! Rise again with both feet and repeat. NOTE: this is advanced, suitable for children over 8-10 with good coordination.
3 × 10 reps per leg. Only if indicated and supervised - 5
Deep heel-down squat
Global mobilization to improve posterior chain flexibility
Squat as deeply as possible keeping BOTH heels on ground. Hold support if needed. If heels lift, place small raise (book, rolled towel) under heels and gradually work to reduce it. Stay in squat position breathing normally, trying to relax into position.
10 reps with 10-second pause at bottom, or hold 30-60 seconds
Frequently Asked Questions
How do I know if my child has a tight Achilles tendon?
The most common sign is inability to squat with heels on the ground. If the child walks predominantly on toes or has difficulty pulling the foot upward (dorsiflexion), specialist evaluation is recommended. The "knee-to-wall" test objectively measures dorsiflexion.
How long does it take to lengthen the Achilles tendon with exercises?
First improvements in dorsiflexion are noticed after 4-6 weeks of consistent stretching. Optimal results require 3-6 months. The key is frequency: 3-4 short stretches daily are better than one long occasional session.
Can Achilles tendon tightness cause problems if untreated?
Yes, a tight Achilles tendon can cause biomechanical compensations: toe walking, compensatory flatfoot, knee pain and forefoot overload (metatarsalgia). Regular stretching prevents these complications.