The Achilles tendon connects the upper calf muscles to the back of the heel bone. When the Achilles tendon becomes degenerative and inflamed, it is called Achilles tendinosis. This may require Achilles Tendinosis Surgery to treat which, depending on the circumstance, will likely involve removing the diseased and damaged portions of the tendon and preventing further injury to the remaining tissue.
The effect of Achilles tendinosis can be painful and swelling can persist. This condition is common in athletes, runners, and people who have calf tightness. The middle of the Achilles tendon can be effected or at the connection point of the achilles tendon and the heel (known as insertional Achilles tendinosis).
Injuries to the Achilles Tendon
An overly stressed Achilles tendon can be subject to mild or serious injuries. If the injury is mild or moderate, it may be limited to burning or stiffness.
Insertional Achilles Tendonitis
Insertional Achilles tendonitis is a degeneration of the Achilles tendon fibers where the tendon inserts into the heel bone.
Tendinopathy and Tendonitis
Tendonitis is the resulting inflammation from tendinopathy (or tendinosis), a common overuse injury caused by frequent and long-term excessive compression.
If alternative therapies such as physical therapy, ultrasound, massage, injections, and shock wave therapy do not alleviate the pain the surgical intervention may be required.
For Achilles tendinosis that effects the middle of the tendon, the surgery focuses on removing the diseased portion of the tendon. If most of the tendon is damaged, the foot and ankle surgeon will often use the tendon that goes to the big toe to support the Achilles tendon after repair. Other procedures may include lengthening the Achilles tendon or calf muscles if they are too tight.
Surgery for insertional Achilles tendinosis is similar. Very often the diseased tissue is removed and the tendon is repaired back down to the heel bone. Surgeons often will shave down the bone spur and smooth it out so that it no longer has the ability to rub the Achilles tendon. Often there is a fluid-filled sac (bursa) that contributes to the pain and inflammation. This bursa frequently is removed during the surgery.
Post operatively the patient will typically wear a splint or boot between 6 to 12 weeks before they can walk on their own. Crutches are utilized during this time as well. Physical therapy is often needed for several months to assist in the restoration of mobility and strength to the repaired tendon. Surgery can predictably return patients to activity. Success rates for Achilles tendinosis surgery are 80-90 percent. Some of the variability depends on the amount of tendon that is diseased at the time of surgery.
Any time a patient undergoes surgical intervention there is a possibility of complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
After this surgery, patients can still have moderate pain. If the tendon is repaired there is still risk of future degeneration of the tendon as the patient ages. However, repeat surgery is rarely required.