The Achilles tendon, one of the largest tendons in our body, is quite susceptible to not only acute injury (rupture), but also chronic injury (tendinosis, thickening). We often see the chronic scenario more commonly than the acute rupture; however, each requires aggresssive treatment options to prevent ongoing pain, disability, and disruption of quality of life.
We see Achilles tendon problems take place at two levels, at the back of the heel bone (insertion at the calcaneus) OR at the midportion of the tendon (higher up from its attachment). In regards to acute rupture (usually occuring above the attachment), this is often a surgical problem and only a small subset of patients benefit from non-surgical treatment. However, the rate of re-rupture is much higher in the non-surgical population, which is why I highly recommend surgical repair. I repair the Achilles through a minimally invassive approach allowing my patients to start walking at 2 weeks and back in regular shoes by 6 weeks! (traditionally this surgery required 6-8 weeks of non-weightbearing)
In the chronic Achilles tendon problem, there is a vicious cycle of micro-tearing/repair that takes place either at the mid-portion of the tendon or at the attachment. In these areas we see thickening of the tendon and as the stages progress we see bone calcifiations developing within the tendon itself. These changes lead to tenderness with shoes rubbing on the back of the heel, discomfort with higher level activity, and even pain with regular everyday walking. Our first line of treatment consists of physical therapy, anti-inflammatories (topical and oral), icing, stretching, and rest. Many patients will see significant improvement with these conservative measures; however those who continue with Achilles issues will require an MRI to evaluate the tendon.
The MRI will often show thickening of the tendon (tendinosis), inflammatory swelling, and even partial tearing. Often times these patients will require surgery to address the tendon damage, bone calfications within the tendon, and strength of the tendon. While this is a large tendon to repair, patients do very well from a post-operative standpoint.
In my retrospective studies performed in Pittsburgh, PA, we found that 95% of patients who underwent my Achilles tendon repair with a local tendon tranfer did EXCELLENT after surgery and 95% of those patients also stated they would undergoe the sugery AGAIN! These patients were back to enjoying life, excercising, and performing activities they had avoided for YEARS.
If you have an Achilles tendon problem, please do not continue to suffer from pain, limited activity, and avoiding the things you love. Allow me to diangose, treat, and return you to the quality of life we all DESERVE!