How can Achilles tendinopathy be managed?

Can you please talk us through the management for Achilles Tendinopathy? With Achilles Tendinopathy, similar to many of the other tendinopathies, the initial management would be to first take a good history and examination of the patient and then investigate this, such as using an MRI scan as we have done in this patient or an ultrasound scan once we've confirmed the diagnosis we can then start treatment. The diagnosis sometimes also requires an x-ray because that helps us delineate the bony features especially if there's any bone spurs so the x-rays will help us delineate the bony features and I'll just show you an x-ray so here we've got x-rays of the back of the heel and this is where the Achilles will come down and insert onto the back of the heel and you can see these little bone spurs that are arising right at the back and this is also a little spike that's arisen called a Haglund's deformity here you can see the actual tendon itself has started to calcify and all of these causes further excuse me further inflammation in the tendon clinically this will look as lumps at the back of the heel and this would relate to insertional Achilles tendinopathy. Further up if we've got a non-insertional Achilles tendinopathy you would have lumps in the actual tendon itself the treatment for both conditions initially is to stretch out the gastrocnemius muscle the gastro soleus complex because we feel that the underlying problem with the Achilles tendon arises from having a tight gastrocnemius muscle and the easiest way to do that is to do a Alfredson step exercise.