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What is the treatment for painful achilles tendon?

How can I tell my Achilles tendon is having troubles?

The Achilles tendon is composed of two muscle groups, Soleus and Gastrocnemius muscles. The Gastrocsoleus spans the knee, ankle, and subtalar joints, making it common that patients to feel pain and tightness from the thigh to the heel and the arch of the foot. When the tendon is severely damaged, there may be a painful enlargement involved, commonly at the mid-substance of the tendon 4-6 cm from the heel bone or directly at the insertion site. Patients may find it hard to do daily activities such as walking, running, and especially walking uphill.

What are the conditions affecting the Achilles tendon?

A large number of patients have tightness in the calf muscles called "the Gastrocnemius". Tightness from this muscle alone can lead to pain in the calf and heel without significant tendon damage. Some medications such as antibiotics in the Fluoroquinolone group may lead to tendon damage. When the tendon has a poor healing response from an injury, it will become enlarged and painful, commonly called "Tendinitis" or "Tendinopathy". These conditions can affect either at mid-substance or insertion of the Achilles tendon. A complete Achilles rupture can be explored here

How can I keep my Achilles tendon healthy?

Flexibility is the key. The collagen fibers in the tendon will respond well to moderate tension force. Stretching exercises such as runner stretch or wall stretch can help maintain flexibility in the muscle and tendon units. The patient should avoid cortisone injection into the Achilles tendon as it may lead to a complete tendon rupture. Consult with your physicians prior to taking antibiotics as some may affect the tendon substance. 

What is the conservative treatment for Achilles tendon problems?

Patients may start with anti-inflammatory medication to help relieve pain. Stretching exercises should be performed regularly. Midstubtance tendinopathy particularly responses well to eccentric exercise. In contrast, insertional tendinopathy may benefit more from strengthening exercise more than stretching. A heel lift may give patients some comfort as it helps decrease hyperextension force and act as a cushion against the heel counter.  Some mid-substance diseases may respond well to PRP injections. Shockwave therapy may also be considered if available.

What are the surgical options for Achilles tendinopathy?

Each tendinopathy is different. A patient with contracture of the Gastrocnemius muscle may benefit from a minimally invasive release of the tendon. Patients with mid-substance disease can take advantage of a minimally invasive approach using arthroscopic debridement techniques. Patients with insertional disease, in the majority, will require more comprehensive reconstruction of the Achilles tendon such as tendon repair, removal of bone spurs, tendon transfers, and a release of contracted gastrocnemius tendon (See picture below).

What is the recovery after Achilles tendon surgery?

Most Achilles tendon surgeries can be performed on an outpatient basis. Minimally invasive procedures for tendon contractures and mid-substance disease will allow the patient to immediately bear full weight in a boot. The boot can be weaned off at 6 weeks. Tendon reconstruction procedures for insertional tendinopathy will require 6 weeks of non-weight-bearing followed by a progressive increase in weight-bearing and activities until 12 weeks post-op that the patient will be allowed to resume normal light activities using normal shoes. 

Author: Phinit Phisitkul, MD

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