Achilles tendon injury (tendinopathy) and pain occur in active individuals, when the tendon is subject to high or unusual load. Achilles tendinopathy can be resistant to treatment, and symptoms may persist despite both conservative and surgical intervention. The pathology of overuse tendinopathy is non-inflammatory, with a degenerative or failed healing tendon response. The diagnosis of Achilles tendinopathy requires excellent differential diagnosis and an understanding of the role of tendon imaging. Conservative treatment must include exercise, with a bias to eccentric contractions. Surgical treatment is effective after complete tendon rupture, but may not assist recovery from overuse tendinopathy. Further research into the clinical aspects of Achilles tendinopathy is required.