There are two areas of the Achilles prone to this problem: in the middle of the tendon (mid-substance Achilles tendonitis) and at its insertion into the heel bone (insertional Achilles tendonitis).


Insertional tendonitis is seen in runners, but also in individuals with a certain shape of heel bone. It presents with pain right at the back of the heel. In both forms of tendonitis the pain is often worst first thing in the morning and after periods of rest, so-called “start up” pain. Once the individual has “warmed up” the symptoms often improve but shoes can be very bothersome where the shoe rubs on the sore area.


Mid-substance tendonitis presents as a painful swelling of the tendon and is often seen in long-distance runners. However, it can follow un-accustomed activity or after a minor injury and rarely in the elderly after taking certain antibiotics (Fluoroquinolones).


Diagnosis of tendonitis is based on the symptoms you are having and a physical examination. If the tendonitis has caused the greasy liquid that protects the tendon to become dry, this can be heard through a stethoscope because of the friction inside the affected area. Any calcium deposits in the tendon or the surrounding sheath can sometimes be seen on an x-ray.


In many people, the condition will improve with time (12–18 months), anti-inflammatory medication, activity and footwear modification but the mainstay of treatment is physiotherapy. Steroid injections should be avoided as they are associated with an unacceptable rupture rate. There has recently been a lot of interest in experimental techniques such as blood injections and dry needling but results have been disappointing.





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