I am a keen 50-year-old walker and have suffered from very painful tendinopathy in my Achilles tendons for 18 months. The only thing that has made any difference is an off-the-peg orthotic. What else can I try before I go quite mad from cabin fever?
Fran Maloney, East Sussex

Some 15-20% of individuals engaging in lower-limb activity will suffer from Achilles tendinopathy (formerly known as tendonitis). It is not an inflammation: the tendon is trying to heal, but does not succeed. Orthotics are used, and are beneficial to some patients. Non-steroidal, anti-inflammatory drugs are very fashionable, but, while temporarily effective, interfere with healing in the long run. Some doctors administer corticosteroid injections around the tendon. They can ameliorate the pain for several months, but the same considerations for non-steroidal anti-inflammatory drugs apply. In addition, some patients may rupture the tendon - a dramatic and painful event. Antibiotics, such as ciprofloxacin, seem to cause tendinopathy: if patients experience tendon problems while taking them, they should be counselled appropriately. "Eccentric heel drop" exercises are effective in relieving the symptoms of Achilles tendinopathy. They need to be performed 90 times a day for three months, and they have to hurt: if they do not, then add a weight.

But if the offending activity is not stopped, the tendinopathy will linger. About two-thirds of patients will eventually improve, but they may have to drop their activity levels, and some 20% may need surgery. Even surgery is not a quick fix - a return to full activity takes six months of appropriate rehabilitation in most patients, with a complication rate of up to 10%.

· Professor Maffulli is a consultant orthopaedic and sports injury surgeon at Keele University medical school. If you have a question for him, email fitness@theguardian.com