Achilles tendinopathy mainly arises from overuse, but is often present in middle-aged overweight patients with no history of increased physical activity [71]. Its natural history in patients who try and continue to exercise is of gradually increasing load-related localized pain coinciding with increased activity. Examination should include thorough inspection to assess for swelling and asymmetry of the involved tendons, range of motion testing, palpation for tenderness, and examination manoeuvres that simulate tendon loading and reproduce pain [125].