Achilles tendinopathy is a common overuse injury. Characteristic Achilles tendinopathy symptoms include morning stiffness, swelling, and pain that is accentuated during physical activities. The mechanisms associated with Achilles tendinopathy are multifactorial and complex. The theory behind this degenerative condition is largely based on a disproportionate volume of tendon loading compared to recovery. Achilles tendinopathy generally presents as either a mid-substance tendinopathy (2–6 cm from tuber calcanei) or insertional tendinopathy. Early distinction between these two locations is highly important as location is a key treatment choice factor. The treatment intervention with the strongest evidence basis is well-structured physiotherapy. In combination with physiotherapy injection, lithotripsy (shock wave), and laser therapy may also be used, however, the supportive evidence basis is weak. If 6 months of evidence-based non-surgical treatment has not improved the condition, then surgical intervention should be considered. For mid-substance Achilles tendinopathy longitudinal surgical incisions are performed to achieve “scarification.” Surgical intervention for Achilles insertional tendinopathy may involve resection of a bony spur on the calcaneus and the deep bursa near the insertion. Surgical procedures can be performed open or with an endoscopically assisted minimally invasive technique.