Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its etiology, pathology and optimal management. Emerging non-operative management and heavy load eccentric strengthening protocols based on these theories have yielded encouraging early results. Operative management traditionally produced good to excellent results, but randomized controlled studies comparing different surgical procedures and prospective evaluation of patient outcomes are necessary to truly establish the efficacy of these procedures. As the biology of tendinopathy is being clarified, more effective management regimens may come to light, improving the success rate of both conservative and operative management.