Achilles Tendinopathy
What is the Achilles tendon?
Tendons join muscles to bones. The Achilles tendon joins the calf muscles onto the heel bone. It is the firm rope-like structure you can feel on the back of your ankle, just above your heel bone.
What is tendinopathy?
As we get older our tendons generally get weaker. If our tendons are weak and we overuse them we can get microscopic tears in the tendon. As these tears try to heal abnormal scar tissue and inflammation occurs in the tendon which is painful.
It is usually caused by tight calf muscles or weak calf muscles, it is important that your doctor decides which of these has caused the problem in you as this would alter the treatment. Being flat footed can cause Achilles tendinopathy, it can be associated with certain medications (steroids and certain antibiotics) or it can happen for no reason whatsoever.
What problems does it cause?
It can be extremely painful, especially in the morning or after resting. It can stop you being able to play sports, run, train or even walk properly. If it is ignored for a long time it is harder to resolve.
Non-surgical treatment:
It is important you are assessed by a specialist to diagnose the problem and its causes properly and design the treatment to suit your specific problem and needs.
Physiotherapy is often the first treatment for this problem.
If the main problem is calf weakness then a strengthening program is needed.
If calf tightness is the cause then a stretching program is needed.
Heel raises in the shoes can also help to take some of the strain off the tendon.
Weight is a big factor as up to 12 times your body weight goes through the tendon during certain activities so if you are overweight a lot of extra force is going through the tendon. If you would like to know more about weight loss please have a look at my “how to lose weight” page.
Sometimes injections may help. Most often this involves taking some blood from your arm, then putting the blood into a special machine, which spins it until it separates out into all its ingredients. The healing factors in blood can then be extracted and injected back into the tendon to stimulate healing. The evidence for this varies, it does not work for everyone and it does not work on its own, but when used together with physiotherapy, stretches and offloading it can have benefit for some patients and is generally safe.
Steroid injections into the tendon carry a risk of tendon rupture and should be avoided.
In some patients “shockwave therapy” may be required, where a very strong dose of special ultrasound is used on the tendon to stimulate healing.
Other options involve massage, acupuncture, dry needling and many more options with variable results.
Surgery
If non surgical options have failed you may require a surgical procedure. Several surgical options are available and this needs to be tailored to your specific problem and needs. This may involve calf lengthening surgery, injections of your own healing factors, keyhole surgery or open surgery to the tendon itself, or even replacing the tendon by transferring the tendon to the big toe.
After surgery
It is important that you follow the specific advice I give you after your procedure, below is for reference only. Specific advice will entirely depend on the treatment you have had.
After surgery you should be comfortable and most patients go home on the same day with a cast or boot on the leg.
For the first 2 weeks you will need to keep your foot elevated above your heart at home to keep the swelling down. This reduces pain and helps the wound to heal.
You may not be able to put any weight through the leg until it has healed, I will advise you on when this is safe.
You may need to take blood-thinning injections to avoid getting a blood clot in the leg.
At 2 weeks your cast will be changed and the stitches will be removed.
Your rehabilitation will be tailored to suit your need and will depend on the surgical procedure I have performed.
It is crucial you don’t smoke (including e-cigarettes) or take anti-inflammatories for 8 weeks after the surgery.
What problems can I have with my achilles tendon?
This website is designed and run by Mr Edward Gee, a Consultant Orthopaedic Surgeon specialising in Foot and Ankle Surgery, as an educational resource for Patients and Professionals.
Achilles Tendinopathy FAQs
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