Achilles Tendinopathy

The Achilles tendon is the largest tendon in the body. It connects the upper calf muscles to the back of the heel bone.

Achilles  tendinopathy occurs when a tendon is unable to adapt to the strain being placed upon it. This leads to repeated small amounts of damage within the tendon fibres, and results in the tendon trying to heal itself in response to the strain.

Sometimes this condition is called Achilles tendinitis or tendinosis, but these terms are used by people to mean the same thing as tendinopathy. It may occur in the middle of the tendon (Midsubstance) or at the point where the tendon connects to the heel bone (Insertional).

The condition is common in athletes, runners, and people who have calf tightness. Other factors include; Weight,  Diabetes, Tight  calf muscles, and stiff joints in the foot.

Common symptoms include;  Morning stiffness which   eases after walking, Tenderness and a painful lump over the Achilles tendon, Variable pain: sometimes settling with exercise, sometimes restricting any activity. 

NON-OPERATIVE MANAGEMENT

Many patients improve without surgery. Rest, oral medications and physiotherapy may help reduce the swelling and pain. Heel cups or cushions can improve pain by taking some of the stress off of the Achilles tendon when walking.

A formal physiotherapy program focused on an eccentric exercise program  is successful in up to 70-80% of cases.

Use forms of exercise that rest the Achilles tendon; swimming, cycling, or pool exercise.

Other treatments such as Ultrasound and Platelet Rich Plasma (PRP) injections may help, with the response being variable.

A  physiotherapy program focused on an eccentric exercise program is attempted, however with variable results.

Other treatments such as Ultrasound and Platelet Rich Plasma (PRP) injections also have a  variable result. Cortisone injections into the achilles are avoided, however a cortisone injection in front of the Achilles may benefit.

OPERATIVE MANAGEMENT

Surgery is performed for ongoing pain restricting normal and sporting activity after Physiotherapy and an eccentric program has not been of benefit. Midsubstance Tendinitis can be treated with small procedure as a day case, with an early rehabilitation regime.

Insertional Achilles Tendinopathy develops calcificied areas and bone spurs develop on the heel. This requires an Achilles trimming and reinsertion with heel bone spur removal. The rehabilitation process takes 3 months.

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