Slow Heel Raises for the Achilles: How to Do Them

A slow heel raise means rising onto your toes and lowering back down under control.

What it's for

Your calf muscles pull on your heel through the Achilles tendon. A heel raise is the simplest way to make that whole chain work. Your calf and Achilles work both as you rise and as you lower, especially when the movement is slow and controlled: as you lower, the calf is still working hard while the tendon is being stretched out. Gradually increasing this load can help build strength and improve the tendon's ability to handle activity over time.

⚠️ When to skip this exercise and see someone in person

Hold off if the pain came on suddenly during an injury rather than building up gradually — that needs its own check-up first. If your pain is right on the heel bone or high in the calf rather than in the middle of the tendon, you don't need to skip heel raises altogether — just keep them on flat ground rather than off a step (see the note below on where your pain is). If a single-leg raise causes sharp pain or feels too hard, use a two-leg or seated version instead rather than skipping the exercise entirely.

• Stop and get checked the same day if you felt a snap or a sensation like being kicked in the back of the leg, if you can't push off or stand on tiptoe at all, or if there's sudden or major weakness.
• Get urgent medical advice for new one-sided calf pain or swelling, especially after travel, surgery, illness or a period of not moving much — this doesn't need a fever to matter. Call emergency services if this comes with chest pain or sudden breathlessness.
• Book an appointment if there's numbness or pins and needles in the foot, or no change after about 12 weeks.
• If Achilles pain or swelling starts while you're taking a fluoroquinolone antibiotic (names ending in -floxacin), stop taking it, rest the area, and contact the prescriber immediately — don't wait for a routine appointment.
• If you're recovering from an Achilles rupture or an operation, follow the rehabilitation protocol your surgical team gave you rather than starting below-step heel raises on your own.

For most people with a grumbly Achilles, this is one of the safest things they can do.

The best-known version of this exercise is the Alfredson protocol, published in 1998 and used ever since for pain in the middle of the Achilles. It asks for 3 sets of 15 slow lowers, twice a day, with the knee straight and again with the knee bent — 180 heel drops a day in total. It works, but 180 daily repetitions is a lot to ask of anyone.

Which brings us to the most practical study on this exercise. A 2014 randomised controlled trial in JOSPT compared the full Alfredson volume against a "do as tolerated" version where people did fewer repetitions, in people with pain in the middle of the Achilles tendon. In this study, the lower-volume group had similar short-term results over 6 weeks — suggesting the exercise matters more than the exact count, and not everyone needs the full 180 a day to get benefit.

One thing to be clear about. This is a strengthening exercise for a tendon that's being built back up. It's not a stretch. Mild discomfort can be okay, but the exercise doesn't need to hurt to work. It's also not a quick job. Tendon strengthening programmes generally run for around 12 weeks.

How to do it

Slow heel raise (starting version) — Stand facing a wall or a worktop with your fingertips on it for balance, feet hip-width apart. Rise up onto the balls of both feet over about 3 seconds. Pause at the top. Lower over about 3 seconds until your heels touch the floor. Start with 2 to 3 sets of 8 to 12, once a day, and build up reps or add weight if the next morning feels okay.

Off a step (next version, midportion pain only) — This version is for pain in the middle of the tendon (roughly 2 to 6cm above the heel), not for pain right where the tendon meets the heel bone — see the note below. Stand with the balls of your feet on the edge of a step, heels hanging free. Rise up over 3 seconds, then lower over 3 seconds until your heels drop below the level of your toes. Same sets and reps as above.

Seated heel raise (easier option) — Sit down with your feet flat and rise onto your toes while seated, adding weight across your knees as it gets easier. This is gentler and also trains the deeper calf muscle — a useful option if standing versions feel like too much.

Knee-bent version — Same as the standing version but with your knees bent to about 30 degrees throughout. This shifts more of the work to the deeper calf muscle. The Alfredson programme includes both straight-knee and bent-knee versions.

A note on where your pain is: pain in the middle of the tendon (midportion) and pain where the tendon attaches to the heel bone (insertional) are different patterns. If your pain is at the heel attachment, keep heel raises on flat ground rather than off a step — dropping the heel below toe level can increase compression right where the tendon meets the bone and may aggravate that kind of pain.

Form cues:

• Lower under control rather than dropping. A slow count — about 3 seconds down — can help you keep the movement controlled.
• Push evenly through your big toe and second toe. Don't let the ankle roll outwards.
• Use your hands for balance only, not to take weight.
• Keep it smooth and quiet. If you're wobbling, use more hand support, reduce the load, or go back to an easier version.
• Mild pain during the exercise is acceptable. Sharp pain, or pain clearly worse the next morning, means do fewer.

Progression note

Progress by adding repetitions, adding weight, or relying less on your hands for support — moving from both feet, to more weight on the sore leg, to one leg, and (for midportion pain only) to a step. Move up a level only when your morning stiffness the day after is no worse than before. You don't need to reach 180 repetitions a day — the 2014 trial found that doing fewer, as tolerated, worked just as well over 6 weeks as the full Alfredson volume. Give it around 12 weeks before judging it.

Bottom line

Heel raises are one of the main strengthening options for gradually-developing Achilles pain, and both the rising and lowering phases count. Start on the floor with both feet, lower under control, and use the next morning to decide whether the dose was right. You may not need the full 180 a day for it to work — a small trial suggests fewer reps can give similar results, though this isn't fully settled — and if your pain is at the heel attachment rather than the middle of the tendon, skip the below-step version and keep raises on flat ground instead.