This study was to evaluate the clinical relevance of neo-vascularization using 3D power Doppler ultrasonography (PDU) in Achilles tendinopathy. A 53-year-old male with chronic mid-portion Achilles tendinopathy was investigated. Quantitative assessment was performed over a twenty four day period. The mean visual analog scale (VAS) score and Victorian Institute of Sports Assessment-Achilles (VISA-A) score were compared with the 3D PDU findings. The overall volume of the neo-vascularization dropped from 463 mm(3) to 117 mm(3) at the final scan. This coincided with considerable improvement in both VAS and VISA-A scores, from 8 to 0 and 2 to 92 respectively.