Achilles paratenonitis and medial tibial syndrome are the most common specific overuse injuries among athletes in Finland, and they are a problem especially in endurance sports, such as long-distance running and jogging. Conservative treatment is often successful, but if it fails operative treatment is necessary. The surgical methods developed in Finland, which are widely used in the treatment of Achilles paratenonitis and medial tibial syndrome, are presented with clinical follow-up results in this paper. The patients operated on for Achilles paratenonitis were some years older than the patients operated on for retrocalcaneal bursitis (mean 38.4 versus 32.3 years). Results after operation were excellent or good in 92.4% of 291 patients operated on for Achilles paratenonitis, 84.2% of the 63 operated on for retrocalcaneal bursitis and 79% of the 47 operated on for medial tibial syndrome. All the patients treated operatively were patients in whom conservative treatment had failed. In conclusion, operative treatment of Achilles paratenonitis or medial tibial syndrome in athletes is indicated when these complaints do not respond to any type of conservative treatment.