Achilles tendinopathy treatment

The Achilles tendon connects the calf muscles to the heel bone. It takes large forces every time you walk, climb stairs, run or jump. Achilles tendinopathy is pain and degeneration in the tendon, either in its middle portion a few centimetres above the heel, or at the point where it attaches to the heel bone (insertional tendinopathy).

It is common in runners, badminton and cricket players, and people who suddenly increase their walking or training. It also affects less active people, particularly with weight gain, tight calves, diabetes, high cholesterol and certain antibiotics (fluoroquinolones). Over time, the tendon can thicken and develop partial tears.

The mainstay is a progressive calf and tendon loading programme over several months, with temporary changes to running or sport, heel lifts and footwear changes. Shockwave therapy is used in some cases. Steroid injections into or around the Achilles are generally avoided because of the risk of rupture.

Surgery to remove degenerated tissue or a bony prominence at the heel is considered for persistent cases that do not respond to months of good rehabilitation. A complete rupture is treated with either surgery or a carefully managed boot programme, depending on the case.