This patient had her left Achilles tendon region examined using observation and palpation. There was swelling and redness at the tendon as well as the myotendinous junction. There was also swelling at the peroneal group tendon sheath and it was painful to palpation. There was swelling in the posterior ankle between the Achilles tendon and peroneal group tendon sheath. This patient has a history of bilateral Achilles Tendon surgery as a child with the intention of lengthening her tendons to reduce severe bilateral pronation and flat footedness. She currently wears orthotics.

Motion palpation of the bones of the left ankle indicated stiffness and swelling with limited ranges of motion at the subtalar joint between the calcaneus and tibia.

Muscle atrophy was evident in the left gastrocnemius and peroneal muscles as well as the posterior tibialis. This patient has a history of severe pronation in both her feet and has worn orthotics in the past as well as currently.

Question: What would your treatment plan be for this patient?