Mr Dishan Singh MBChB, FRCS, FRCS(Orth)

Consultant Orthopaedic Surgeon, Foot & Ankle Specialist

Achilles tendon pain (Achilles tendinosis)

Achilles tendinosis is a common overuse injury; it is more common in middle-aged recreational athletes. The commonest causes of Achilles tendinosis are inflexibility of the tendon and over-pronation (excessive flattening of the arch of the foot, causing stress is put on the tendon upon impact). Other contributing factors include inadequate stretching prior to sports, tight Achilles tendon, recent changes in footwear or changes in training schedules, eg increasing mileage.

Treatment (non-operative)

Stretching of the Achilles tendon is the single most important measure.

Physiotherapy may be helpful - your physiotherapist will be able to advise you on the best exercises to perform and simple measures for reducing inflammation. Orthotics such as arch supports may be prescribed for you - these are placed inside your shoe to correct mechanical abnormalities such as over-pronation; these insoles help reduce stresses in the Achilles tendon and can be extremely effective. Some patients report that their orthoses feel a little uncomfortable at first, but with patience and gradual introduction you should find that they become more comfortable.

A night splint to hold your ankle at a right angle at night is usually helpful, especially in patients whose symptoms are worse in the morning.

Anti-inflammatory tablets can be prescribed: these help to reduce pain when there is inflammation. Mr Singh recommends local ice massage twice a day. Steroid injections are rarely used.

Treatment (operative)

In a small number of cases the tendinosis does not improve even after 12 months of appropriate treatment. Surgery is then considered to remove any inflamed or damaged tissue from the tendon to promote healing. In Insertional tendinopathy, the bony heel bump or Haglund deformity is removed along with the inflamed tissue. If surgery is performed, the calf and foot are placed in a plaster cast for 4-6 weeks.

Read more about Achilles tendinosis including exercises:

 A patient's guide to Achilles tendinosis (Achilles tendon pain)

Achilles tendinosis

Achilles tendinosis

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