Treatment for Pain Medial to the Achilles Tendon

Diagnostic Considerations

The American Academy of Family Physicians notes that true Achilles tendinopathy presents with posterior heel pain proximal to the tendon insertion with thickening and tender, palpable nodules on examination 1
Pain medial to the Achilles tendon may represent flexor hallucis longus (FHL) tendinopathy or tibialis posterior dysfunction, characterized by pain medial and deep to the Achilles 1
The American Academy of Family Physicians recommends that EMG and nerve conduction studies are required for confirmation of nerve entrapment, such as tarsal tunnel syndrome, in patients with medial ankle pain 1

Radiographs are the first-line imaging modality for all heel pain to identify fractures, spurs, and Haglund deformity, as recommended by the American College of Radiology 2
If the diagnosis remains unclear after clinical examination and plain films, MRI or ultrasound may be used to evaluate soft tissue pathology, according to the American Institute of Ultrasound in Medicine 2

The American College of Sports Medicine recommends eccentric strength training as the most effective treatment option for tendinopathy, which should be started immediately 3
The American Podiatric Medical Association suggests that shoe orthotics to correct overpronation or pes planus problems, addressing underlying anatomic misalignment, should be used in conjunction with other treatments 3
Approximately 80% of patients fully recover within three to six months with conservative outpatient treatment, including relative rest, icing, and NSAIDs for acute pain relief, as reported by the American Academy of Orthopaedic Surgeons 3