Is my only hope

I am a 73-year-old man who for many years has enjoyed running several times a week. Last September I pulled my right achilles tendon (which has happened a couple of times over the years) and it is still giving me trouble. I have tried physiotherapy, icing, rest, ibuprofen and magnesium spray, all to no avail.

Now my doctor has suggested a steroid injection into the tendon and says that with my active lifestyle I will need one every three months. What is your opinion?

ATHE Achilles tendon, which is the largest tendon in the body, connects the muscles at the back of the calf with the heel bone. It is used whenever you walk, run or jump and although it is very strong, it is prone to becoming worn or injured, especially in runners.

This leads to pain and stiffness that worsens after exercising. In the past it was thought that all Achilles tendon pain was caused by inflammation, where the tendon becomes thickened and sore. It’s now known that in many the pain is caused by tiny tears in the tendon fibres, caused by long-term overuse.

Although steroid injections can be of some help where there is inflammation, they are unlikely to help a worn tendon and in fact may make it more prone to a larger tear or rupture. The best way to minimise discomfort and to promote healing of the tendon is to take the strain off it as much as possible. This means avoiding running and wearing a heel lift inside your shoes when walking. Strapping the tendon may also be helpful, together with stretching exercises to improve ankle stability.

I think this type of problem is best treated by a specialist physiotherapist so I suggest you ask your GP for a referral. Be patient. Achilles tendinopathy can take a long time to resolve.

aBOUT 17 months ago I woke in the morning feeling extremely dizzy. my doctor tried the Epley manoeuvre but it didn’t work. I’ve now been given various drugs but none of them have helped, so it has been suggested I do balance calorics which I’m told is a test not a treatment.

I’m reluctant to go through with this as l get very anxious and am losing my confidence. What is your advice? I am 84.

ATHERE are numerous different causes of dizziness, including low blood pressure and narrowing of the arteries to the brain but the most common cause is a problem with the balance system in the inner ear, or in the nerves that connect the balance system to the brain.

Inside the inner ear are three tiny semi-circular canals that are filled with fluid which moves as you move your head.

The movement of the fluid is detected by tiny fine hairs that line the inside of the inner ear, which then send information to the brain via the vestibular nerve.

With increasing age, debris can collect in one or more of the semi-circular canals which can disrupt the movement of fluid, giving a sensation of dizziness particularly when you move your head.

Epley’s manoeuvre, which involves a doctor turning the head very carefully into different positions, aims to dislodge any debris and can be very successful. However, the fact it didn’t work for you suggests there is another cause behind your problem.

Unlike Epley’s, which is a treatment, balance calorics is a diagnostic test to try to identify