Achilles Tendon Non-Surgical Treatment
Early treatment of Achilles tendonitis depends on whether it is insertional or non-insertional. Insertional tendonitis is an inflammatory condition and is treated with non-steroidal anti-inflammatories, eccentric stretching exercise, and a silicone heel lifts.
Non-insertional Achilles tendonitis occurs in the “watershed” area of the Achilles with limited blood supply. This is usually thought of as damage to the tendon with limited blood supply which would heal the injury. Initial treatment involves stretching exercises and relative rest for the tendon with use of a heel lift.
In cases that present more severe symptoms, we may prescribe a boot, crutches, or complete immobilization of the ankle (cast). Other minimal invasive treatment includes the use of biologic injections into the tendon including PRP or BMCC. Steroids are not recommended as these can weaken the tendon and lead to rupture.
Surgical Treatment of Achilles Tendon Injury
In many cases, surgery will not be necessary in patients who have Achilles tendonitis. If conservative treatment fails to work after weeks to months, our physicians may suggest surgery. Surgery for Achilles tendonitis will depend on the location of the disease and the amount of damage to the tendon.
Achilles Tendon Surgical Procedures:
A surgical stretching or lengthening of the calf muscle is known as gastrocnemius recession may be recommended. Patients with tendonitis typically put additional strain on their calf muscles because the tendons become thick and tight. Patents who have a difficult time stretching or flexing their feet may benefit from this procedure. During this technique, one or two of the muscles that make up the calf are lengthened to allow for this additional flexibility.
For insertional Achilles tendonitis with a Haglund’s deformity, a debridement of the diseased tendon and excess bone is typically recommended. This procedure is done with a direct posterior incision and involves a few weeks of non-weight bearing after surgery to allow the tendon to heal.
Non-insertional Achilles tendonitis is treated surgically with percutaneous or open debridement (removal) of diseased tissue. Percutaneous removal is typically done with ultrasound guidance and the use of a Tenex device. Diseased tissue is removed by the back and forth action of a needle placed into the damaged tissue. This procedure typically allows for immediate weight bearing in a CAM boot.
Open debridement of non-insertional Achilles tendonitis is the other surgical option. This involves a larger incision and direct, open removal of diseased tissue. A transfer of the flexor hallicus longus muscle is occasionally needed to add strength to the Achilles tendon after open debridement.