What could be my problem?
Achilles Tendinitis, Tendinosis or Achilles Tendon Tear. Tendinitis is inflammation of a tendon. Inflammation is the body’s natural response to injury or disease and often causes swelling, pain or irritation. There are two types of Achilles Tendinitis based upon which part of the tendon is inflamed.
- Non-insertional Achilles Tendinitis occurs when fibers in the middle portion of the tendon have begun to break down with tiny tears and they begin to swell and thicken
- Insertional Achilles Tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) into the heel bone.
In both types of Achilles Tendinitis damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles Tendinitis.
Achilles tendon problems can get worse if not treated. After the initial inflammatory phase (tendinitis) the tendon may undergo changes (tendinosis) instead of healing. Over weeks or months, the tendon may develop microtears and swelling, frequently resulting in a tender, visible nodule where the tendon is thickened. Weakened tendon tissues are at increased risk of partial tearing or complete rupture.
What causes Extensor Achilles Tendinitis or Achilles Tendinosis?
- Repetitive stress to the tendon
- A sudden increase in the amount or intensity of exercise activity
- Tight calf muscles and aggressive exercise
- Bone spur where tendon attaches rubbing against the tendon.
When to see a foot doctor about Achilles Tendinitis or Achilles Tendinosis:
- Immediately: if you have experienced a sudden “pop” in the back of your calf or heel. This may indicate a ruptured Achilles Tendon.
- Severe pain along the back of the heel the day after exercising
- Swelling that is present all the time and gets worse throughout the day with activity
- Pain along the tendon or back of the heel that worsens with activity Pain and stiffness along the Achilles Tendon in the morning.
If I have Achilles Tendinitis or Achilles Tendinosis, what are my foot pain treatment options?
If pain does not improve after six months of conservative treatment, surgery may be recommended by your foot specialist. The type of surgical treatment depends on the location of the tendonitis and the extent of damage to the tendon.
- Gastrocnemius Recession: One of the two muscles that make up the calf is lengthened to increase the motion of the ankle. This procedure can be performed with a traditional, open incision or with a smaller incision and an endoscope.
- Debridement and repair: (If the tendon has less than 50% damage) This operation is to remove the damaged part of the Achilles Tendon. Once the unhealthy portion of the tendon has been removed, the remaining tendon is repaired with sutures or stitches to complete the repair. In insertional tendinitis the bone spur is also removed. This procedure is followed by a removable boot or cast for two weeks.
- Debridement with tendon transfer: (Tendon has greater than 50% damage) The remaining portion of the tendon is not strong enough to function alone. To prevent the remaining tendon from rupturing an Achilles Tendon transfer is performed. The tendon that helps move the big toe point down is moved to the heel bone to add strength to the damaged tendon. The big toe will still be able to move, and most patients will not notice a change in the way they walk or move. This procedure is followed by up to twelve months of physical therapy and/or home exercise before they are pain free depending on the extent of the damage.