This is inflammation of the Achilles tendon, the main driving force for walking that allows you to get up on your toes and run.
It can present with pain, swelling and tenderness in the Achilles tendon, and in the heel around where the tendon inserts. It is often worse in the morning when you first get out of bed, and after exercise. Occasionally, it can present with a spontaneous rupture, although this is rare.
It can be due to repetitive loading due to running and jumping; and occasionally due to shoe wear. There is also an association with older sportsman and runners.
Sometimes a condition called Haglund’s deformity can be involved. This can be a normal anatomical variation involving a spur on the top of the calcaneus; it can jam in to the Achilles tendon with repetitive use of the ankle.
The initial treatment is physiotherapy and rest, and orthotics with an arch support. If this shows no improvement in 3-6 months, surgery can be indicated. Around this time it is occasionally worthwhile trying an ultrasound-guided injection in to the retrocalcaneal space – if the injection gives good relief, even if short-lasting, it can indicate the likely response to surgery.
Generally, surgery involves debriding the inflamed areas of the tendon, and shaving off the bone spurs. You will then be in a cast for a week or so, then a “moonboot” for a month in total. The last two weeks of this period you can walk in the boot, and take it off at night for sleeping. After this period you start a physiotherapy regime, the goal being gentle straight-line running in 6-8 weeks (for younger patients), and comfortable walking in 3-4 weeks (for older patients).