Problems such as yours are common, but can be difficult to treat.

Although inflammation has traditionally been blamed for the pain, pathology studies of the tendons don't usually show much evidence of inflammation.

Instead, the problems seem to be more related to degeneration or breakdown of the tissues. Some studies suggest there may be a brief period of inflammation followed by degeneration.

The reason for mentioning this is that steroid injections are used to dampen down inflammation. If your Achilles tendon problem has been rumbling for some months, you may be past the stage of inflammation so steroid injections may not be that helpful.

The only reliable study of this treatment looked at Achilles paratenonitis - a condition where there's a problem with the tissue layer covering the tendon. It found that steroid injections combined with local anaesthetic were no more effective than local anaesthetic injections alone in reducing pain and tenderness or helping a return to normal activity.

Having said that, many experts use steroid injections for tendon problems like yours and many people find it gives them a lot of improvement. So if you're in a lot of pain and other things haven't helped, you may want to give it a try.

Safety concerns

There are some concerns about safety, and it's usually recommended that steroids are only used once other treatments have been tried intensively for two months without success.

There have been worries that injections into the Achilles tendon may increase the risk that the tendon will rupture. The doctor should only inject around the tendon and not directly into it.

You should avoid overuse of the tendon after the injection, resting for at least two weeks and avoiding heavy exercise for six weeks.

To reduce risks, injections shouldn't be used if you have any problems with infection, clotting of the blood or if the tendon has been torn.

Many people have general concerns about steroids and suppression of the immune system, or other side effects. However these aren't a significant risk from single, localised injections of a steroid drug, but more a problem when steroids are given as a course of tablets, cream (which can cause thinning of the skin) or sometimes inhalers.

This article was last medically reviewed by Dr Trisha Macnair in January 2008