Achilles Tendinitis

Non-insertional Achilles tendinitis occurs when increased stresses are presented to the Achilles tendon with either repetitive microtrauma or acute injury. This stress causes some of the fibers of the Achilles tendon to be injured, however not completely torn. Over time increased degeneration can happen and scar tissue can form.

Insertional Achilles tendinitis occurs over time and is mostly seen in patients over the age of forty but can happen at any age. Insertional Achilles tendinitis is quite commonly a result of increased bone formation known as a heel spur on the insertion of the Achilles. With every step that is taken slight microtrauma occurs at the insertion of the Achilles tendon on the heel bone, which over time will result in scar tissue formation, calcification, and bone formation resulting in a heel spur.

The diagnosis of Achilles tendinitis begins with a thorough discussion and physical examination by a foot and ankle specialist. X-rays are utilized within the office to evaluate for possible heel spurs or calcification within the tendon itself, increased overall thickness of the Achilles tendon can also be visualized. Onsite ultrasounds allow for increased visualization and evaluation of the Achilles tendon. MRIs can be utilized for more specific evaluation of the Achilles tendon.

• Bracing/Orthotics –Walking boots or Shoes with a heel lift take the pressure off the Achilles tendon
• Anti-inflammatory medications
• Shoe modification – Shoes with a soft or no back, or a wedge sandal can be very beneficial in the female population
• Calf stretching exercises - Decreasing the forces from a tight calf muscle is key. Calf stretching exercises should be done on a daily basis.
• Physical Therapy
• CBD – CBD is a natural, nonsurgical way to help treat Musculoskeletal related pain and inflammation
• PRP and Stem Cell injections are nonsurgical ways to treat pain and inflammation associated with Achilles tendinitis

Depending on the extent of the tendinitis and scar tissue within the Achilles tendon, different surgical treatments may be utilized.

Gastrocnemius recession

A gastrocnemius recession can be utilized in patients with tight calf muscles. In this procedure part of the muscles that makes up the Achilles tendon, the gastrocnemius aponeurosis is lengthened to increase flexibility and decrease strain on the Achilles tendon.

Debridement of the Achilles tendon

In areas of focal Achilles tendinitis, the scar tissue can be removed and the underlying Achilles tendon can be primarily repaired. Amniotic grafts are also utilized to help prevent further scar tissue formation and aid in the healing process.

Removal of heel spur and Achilles tendon repair (picture of retrocalcaneal exostectomy)

With insertional Achilles tendinitis, removal of the heel spur on the back of the heel is required for pain relief. In the surgery the Achilles tendon is detached from its insertional point the heel, the spur is removed with a saw and all bony prominences are further smoothed. The Achilles tendon is reattached back onto the heel bone with bone anchors.

Achilles tendon repair and tendon transfer (image of flexor houses longus tendon transfer)

This is known as a flexor hallucis longus tendon transfer. In this procedure the unhealthy tendon is debrided and repaired. The tendon that moves the big toe down is then transferred to further support and increase blood supply to the affected area of the Achilles tendon