Typical initial treatment includes rest, heel lifts, anti-inflammatories, ice, physical and massage therapy, and sometimes orthoses. Surgery is reserved for resistant cases. Achilles paratendonosis is inflammation of the fatty covering of the Achilles tendon. This condition often presents as diffuse swelling of the tendon, and, in contrast to tendonitis, it usually gets worse with activity. Massage directly on the tendon, heel lifts and ice all seem to make paratendonosis worse.
Chronic cases do very well with surgery.
One should note that tendonosis and paratendonosis can co-exist. This is especially common with runners who have ignored symptoms for more than a year. Any tendon or ligament can calcify when it undergoes stress. Occasionally the Achilles calcification fragments or breaks making it symptomatic. If the usual measures mentioned above for tendonitis don't calm symptoms down, then surgery may be recommended.