Achilles tendinopathy affects athletes, recreational exercisers and even inactive people. The pathology is not inflammatory; it is a failed healing response. The source of pain in tendinopathy may be related to the neurovascular ingrowth seen in the tendon’s response to injury. The treatment of Achilles tendinopathy is primarily conservative with an array of effective treatment options now available to the primary care practitioner. If conservative treatment is not successful then surgery relieves pain in the majority of cases. Directing a patient through the presented algorithm will maximise positive treatment outcomes.