Treatment of the insertion of Achilles tendonitis begins with rest, elevation of the heel on the sole of the shoe and physical therapy treatments. All of these are designed to decrease the inflammation on the tendon. Inflammation occurs with every step taken when walking because of the stretching of the Achilles tendon.
Padding of the shoe, elevated heels and physical therapy treatments are commonly successful. Cortisone (steroid injection) should not be used to treat inflammation of the insertion of the Achilles tendon since this can lead to further deterioration of the tendon itself.
If conservative treatments are not sufficient, surgery may be the best treatment option. The surgical procedures performed are varied and are determined by the underlying problem. For example, if the bone on the back of the heel is very prominent and is digging into the Achilles tendon, the bone is trimmed and shaved.
Alternatively, the tendon may need to be repaired if there is tearing of the tendon where it attaches to the bone. In addition to repairing the tendon, a transfer of a tendon is used (transferring the tendon to the big toe, called the flexor hallucis longus). This tendon transfer adds strength and support to the weakened damaged tendon.