Achilles tendonopathy
Achilles tendonopathy produces a painful heel, often with the formation of lumps or nodules in the Achilles tendon. Most people are able to tell that the heel pain is arising in the tendon rather than in the heel bone. Sometimes however the tendon develops a problem in the very final centimeter or so where it attaches to the heel bone (calcaneous) and under these circumstances it can be very difficult to tell that this is a tendon problem rather than something in the bone.
The Achilles tendon has to take the strain of several times body weight. It can suddenly become tender as an over use injury in response to a change in running shoes etc etc.
insoles often cure it. Tendons can develop wear and tear changes over the years, sometimes with little or no discomfort even though the tendon is becoming weaker. Indeed this weakness can sometimes result in the tendons snapping during some form of exertion without any prior warning. If pain and swelling do develop it can happen fairly gradually. It will settle down in most cases but the very slow recovery process is notoriously difficult to speed up.
Physiotherapists successfully treat most patients by biomechanical correction of any foot posture abnormalities by treatment aimed at stretching the Achilles tendon/calf muscle tissue and stimulation of the healing process by a rather uncomfortable deep friction or massage treatment. Simply resting the Achilles tendon, perhaps by using a plaster cast or removable boot, can settle a very painful episode but is usually not the permanent solution since the problem tends to come back once activities are resumed.
The key is to frequently stretch the tendon tissue in a controlled fashion, stimulate healing but using the tendon all the time without adding to the injury. Getting this fine line rigth plus the intrinsically slow nature of the tissue repair process, is what makes the recovery a long drawn out affair. Non-surgical treatments are employed for at least six months before surgery is contemplated. Occasionally surgery is utilised to excise the worn out areas of tendon and repair it, to take some of the tension out of the calf muscles (gastrocnemius slide) or to shave down any bony spurs at the heel which might be rubbing on the last centimetre or so of tendon, if that is where the problem resides. Occasionally the tendon is so worn out that a whole section has to be removed and replaced by an adjacent tendon which can be spared for the purpose (flexor hallucis longus transfer).
There is very rarely any place for steriod injections because although they are powerfully anti-inflammatory, they do not encourage healing. On the contrary, steroids deminish the healing response, soften the tendon and can cause it to rupture.