Tendon Issues

What is Achilles tendonitis?

Achilles tendonitis is a painful chronic condition that occurs when the Achilles tendon becomes irritated and inflamed.  

What is the Achilles tendon?

The Achilles tendon is the fibrous connective tissue that connects the calf muscle to the heel bone.  It is the largest tendon in the body and runs down the back of your lower leg.  It functions every time you walk, run, climb stairs, jump and stand on your tip toes.  

What causes Achilles tendonitis?

Achilles Tendonitis is generally a result of overuse or repetitive activities.  It is not typically related to a specific injury, but certain activities may make it more likely to develop such as sudden increase in exercise activity, tight calf muscles and heel spurs.

Tendon Issues

What are the symptoms of Achilles tendonitis?

Achilles tendonitis is generally a result of overuse or repetitive activities.  It is not typically related to a specific injury, but certain activities may make it more likely to develop such as sudden increase in exercise activity, tight calf muscles and heel spurs. 

Tendon Issues

Are there different types of Achilles tendonitis?

Achilles tendonitis can occur in different areas of the tendon and are more common in different patient populations.  

Insertional Achilles tendonitis is a pain and thickening of the Achilles tendon as it attaches to the heel bone.  This usually occurs in middle aged patients with tight calf muscles and is due to repeated inflammation secondary to trauma.  This leads to pain at the back of the heel and an enlargement of the bone of the back of the heel known as a Haglund’s deformity can develop.

Mid-substance Achilles tendonopathy is a pain and thickening of the Achilles tendon 2-6cm away from the insertion of the Achilles tendon into the heel bone.  It is usually due to overuse, poor tendon blood supply and some inflammatory conditions.

 The tendon is thickened, painful and swollen and patients tend to have difficulty running.  This often occurs in patients in their 30’s and 40’s.

How do you diagnose Achilles tendonitis?

All surgical procedures involve inherent risk of complications.  However, these risks are generally uncommon and quite infrequent.  These include anesthetic complications, wound infections, deep Dr. Chow will take a thorough medical history to delineate the nature of the pain, evaluate the degree of functional impairment and assess any deformity that may be present.  

A physical examination will be undertaken to evaluate the areas of tenderness, the range of motion of the ankle and isolate any other areas that may be symptomatic.

Imaging is essential to evaluate the tendon and surrounding bone.  Weight bearing x-rays will be required to assess the alignment of the ankle and assess the size of the heel spur.  MRI is also required to assess the quality of the tendon and the degree of degeneration infections, nerve injury resulting in numbness/tingling/pins and needles. tendon injuries, bleeding, stiffness, chronic regional pain syndrome, blood clots and ongoing pain.

Patients can minimize the risk of complications by carefully following post-operative instructions.

What are the non-operative treatment options for Achilles tendonitis?

The first line of treatment of Achilles tendonitis is always non-operative management.  Non operative management consists of activity modifications, shoe wear modifications with shoe lifts, anti-inflammatory medications, and physiotherapy.  Physiotherapy is the mainstay on non-operative management and will focus on eccentric training and possibly shockwave therapy. 

Non insertional Achilles tendonitis responds better to non-operative management with a 65-90% success rate while insertional Achilles tendonitis has a success rate of approximately 50%.

What are the operative options available for Achilles tendonitis?

Operative intervention for Achilles tendonitis is only considered if the patient has failed all attempts at non-operative management.   

Non insertional Achilles tendonitis is treated with an open excision of the degenerative tendon, tubularization of the tendon and injection of platelet derived growth factor. 

Insertional Achilles tendonitis is treated with an open excision and detachment of the degenerative Achilles tendon, removal of the bone spur on the heel and reattachment of the tendon.

Foot Arthritis

What can I expect after Achilles tendonitis surgery?

Expect to stay in hospital for 1-2 nights for observation and while the physiotherapists help you with swelling management and teach you how to be safe non weight bearing with crutches.  Blood thinners are commenced immediately and continued for the duration of treatment. 

You will initially be placed in a plaster with your foot pointed to the ground for 2 weeks.  At your first post-operative visit at 2 weeks you will be changed into a boot and commenced on Dr. Chow’s functional Achilles tendon protocol.  Expect to be in a boot for up to 10 weeks before being transitioned to a normal shoe.  Long distance walking is usually achieved at around 6 months and up to 12 months is often required for full recovery.

Potential complications of Achilles tendonitis surgery

All surgical procedures involve inherent risk of complications.  However, these risks are generally uncommon and quite infrequent.  These include anesthetic complications, wound infections, deep infections, nerve injuries, tendon injuries, bleeding, failure of tendon to heal to the bone, ongoing pain, stiffness, chronic regional pain syndrome, blood clots, failure of the procedure to relieve all of the presenting symptoms and recurrence of the pain or heel spur.

Patients can minimize the risk of complications by carefully following post-operative instructions.

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At Care First Orthopaedic our team of highly experienced surgeons provide comprehensive treatment and management for all orthopaedic conditions. Our comprehensive services help you achieve better bone and joint health to sustain an active lifestyle.

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