Howdy courtrage, help is on the way -
1. I am currently working on a lengthy post with 20+ links on this topic. I've been sidelined with severe, chronic, achilees problems (plus knee and back issues) the combination of which eventually prevented me from playing from sept 05 to sept 06. I promised the board if i ever got back on the court again i would share how i did it. I intend to keep the promise.
2. I have (with the help and encouragement of the TT community) succesfully beaten the achilles problem, and have worked up to playing 3 times per week, for 1.5 - 2 hours each. My method was partially traditional, ( ice, rest, anti-inflammatory medication, orthotics, etc...) but did contain a largely unknown, but research supported training regimen. I'll try to get my post up on the board soon. Till then, hang in there, keep the faith.
3. In terms of the internal debate we have in this thread....The use of orthotics for the treatment of achilles problems, as part of an overall plan, is virtually undisputed within the medical community. Nobody disputes that this particular tactic deserves a place in the doctors bag o tricks. The usefulness of orthotics will however, vary from person to person. For NBMJ, it proved to play quite a large role for his particular flavor of problem. Ed had quite a few very helpful posts for me, and I'm eternally grateful for his contribution on this subject. The final solution will vary from not only from one patient to the next, will also vary in terms of treatment form one doc to the next. I saw 4 different doctors, and at least a dozen physical therapists. What was common about all of them, is they all had slightly different approach in what they wanted to try first. There is no magic bullet here. It is a matter of finding what works for you. It is largely a matter of trial and error.
4. Achilles tendinopathy occurs in two flavours, the type that clears in a few weeks or days, and the type that is much more persistent. For the much more persistent, chronic flavor, it would seem that tendinitis (the suffix itis means inflammation) is the less probable cause. If you are symptomatic for longer than a few days or weeks, the evidence starts to tilt more strongly in favor of tendinosis (tissue structure degenerative damage) being the culprit. There is currently a very real debate within the medical community as to which is more prevalent. The easy answer to this debate is this... anti inflammatory meds will either work, or they won't. If it works short term, but you are symptomatic upon returning the the sport, you have a muscular, and or structual weakness that needs correcting. The cure for mscle weakness is muscle strength. If you have some sort of bony deformity that predisposes you to suffer achilees bursitis, the last resort here is surgery. Even with surgery, you will have to rebuild the muscle. In the end, any way you slice it, this thing is about strength and flexibility. The bones are not going to move themselves. Aim for slow and steady progress with PT. This achilles deal just loves to throw huge peaks and valleys at you, and then it's difficult to gauge what you did right, did wrong, too much or too little. Slow and steady progress wins this race. Strength and flexibilty is the key. Inflammation is the pest that gets in the way of the gaining the strength. It is a catch 22, that CAN be overcome with just the right amount of each ingredient.
Best regards, take care
-Jack