Are you struggling with acute or chronic heel or Achilles pain? If so, you are not alone. Chronic pain affects up to an estimated 1.6 million Australians, making it one of the country's most significant health burdens. But why does pain persist in some people long after the tissue has healed — and what can be done about it?
Acute Pain: The Warning System Working
Acute pain serves a biological purpose. When tissue is injured — whether a muscle tear, a fascial overload, or bone stress — nociceptors (pain-sensing nerve endings) activate and send signals to the spinal cord and brain. This is a warning system: pain tells you to reduce load, protect the tissue, and allow healing to occur.
Acute pain is proportional and informative. It resolves as the tissue heals. For most lower-limb injuries managed appropriately, acute pain should begin resolving within 6–12 weeks of consistent conservative management.
When Pain Becomes Chronic: Central Sensitisation
Chronic pain is defined as pain persisting beyond 3 months, or beyond the expected healing time of the original injury. At this point, something changes in the nervous system itself — a phenomenon called central sensitisation.
Central sensitisation occurs when repeated pain signals cause the spinal cord and brain to become more sensitive to input. The volume of the pain system is turned up. Things that should not hurt, do. Normal movement becomes associated with pain — not because the tissue is damaged, but because the nervous system has been recalibrated to interpret that movement as threatening.
Central sensitisation is why chronic plantar fasciitis can hurt with a light touch; why Achilles pain can worsen despite perfectly adequate tissue healing on ultrasound; and why identical injuries in two different people can have dramatically different recovery trajectories.
Why Some Suffer More Than Others
Several factors increase the likelihood of acute pain transitioning to chronic pain:
- Catastrophising — interpreting pain as a sign of serious ongoing damage
- Pain-related fear and avoidance — reducing all activity due to pain, which reduces tissue capacity and reinforces pain sensitivity
- Poor sleep — significantly amplifies pain perception
- Psychological stress — the nervous system does not separate physical and emotional threat
- Previous chronic pain — sensitisation has already occurred
What to Do About Chronic Pain
The key insight from pain science is this: if pain is no longer accurately representing tissue damage, then the goal of management shifts from tissue protection to nervous system recalibration. This is achieved through graded exposure to loading — carefully introducing activity at levels below the pain threshold and progressively building capacity.
This is exactly why bracing has a role in chronic pain management. The Orthopaedic Sleeve reduces the per-step load at the heel, Achilles, and calf — allowing people to move at a level that is beneath the pain threshold, re-establishing the association between movement and safety rather than movement and pain.
From Pain to Performance — The Orthopaedic Sleeve Society (TOSS)