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Achilles Tendon Injuries: injury types and treatment options

The achilles tendon

UFAI's Dr. Bob Baravarian explains the difference between the three primary Achilles Tendon injuries, Achilles tendonitis, Achilles tendonosis and an Achilles Rupture.

The Achilles tendon is the thickest and strongest tendon in your body, running down the back of the calf, connecting your calf muscles to your heel bone.  It's amazingly strong and can withstand more than a 1,000 pounds of force.  But when it’s injured, it can not only be very painful but also put a swift end to mobility, as you once knew it.

 

UFAI is the best choice for your achilles care

University Foot and Ankle Institute is at the forefront of treatment for all Achilles tendon injuries. We have the most technologically advanced equipment available to diagnose and treat all Achilles injuries, from a mild case of tendinitis to a ruptured Achilles that requires surgery.

 

Although these are complex surgeries, the doctors at University Foot and Ankle Institute have extensive knowledge and expertise in Achilles tears and their treatment. New technologies that include special hardware, which we helped develop in partnership with several manufacturers, along with advances in graft material have led to dramatic advances in the reconstruction of Achilles tears.

 

 

Prior to surgery, snowboarding had become extremely painful with numbness, sharp pain & an overall inability to have control over my foot. This past weekend I went snowboarding & was completely amazed at how incredible my foot felt! Virtually NO Pain! I just wanted to thank you & let you know how grateful I am. Now on to Salsa dancing! CC

Common Achilles Tendon Injuries

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If your doctor determines that your Achilles tendon is the source of your problem, they will likely diagnose one of following four injuries: 

 

Achilles tendonitis

Achilles tendonitis (inflammation of the tendon) is soreness or stiffness of the Achilles tendon and the pain is usually localized in the back of the tendon, just above its attachment to the heel bone.

 

It is essential to seek treatment within days if the pain does not significantly decrease. Waiting too long or ignoring your pain or injuries can lead toe a condition called Achilles Tendonosis, which is explained next.

 

Learn more about Achilles Tendonitis here.

 

 

Achilles tendonosis

Achilles tendonitis is very similar to tendinitis with one critical difference,  it has now become a “chronic” condition, usually because the injury wasn’t properly treated early on. It is also painful since scar tissue has had plenty of time to form and has been pulling on the tendon for some time.  Some patients will try to ignore the pain and “wait it out.”   This generally is not a good idea because after a while your body gives up trying to fix the injury and “accepts” that this injury is never going to go away. 

 

At this point, without medical intervention, your body is usually correct and this pain is going to remain or get worse over time. Luckily Achilles tendinosis is highly treatable thanks to modern medicine, but more difficult to treat once the condition becomes chronic.  This is why seeing a doctor early is the smartest approach to Achilles and most other physical injuries. The earlier you can treat them, the greater your odds of avoiding more advanced and expensive treatments.  To avoid tendinosis, it is essential to seek treatment within days if the pain does not significantly decrease!  Do not ignore your pain or injuries.

 

Learn more about Achilles Tendinosis here.

 

 

Achilles tendon rupture or tear

Achilles tendon ruptures and tears (partial and full) are injuries that are most likely to occur during physical activities requiring sudden eccentric stretching, such as when sprinting and jumping.  Sometimes this is also called “tendinopathy” because of the combination of tendon pain, swelling and impaired performance. These injuries can be serious and are usually extremely painful. Serious tears can also prevent you from even walking. This is the injury that Kobe Bryant of the Los Angeles Lakers had at the end of the 2013 NBA season.  The pain profile for this injury includes sudden or sharp pain, swelling, bruising or the inability to point your foot down or stand on your toes. You may have also heard a loud pop when the injury occurred, which is what Kobe Bryant heard when his Achilles tore.

 

Surprisingly, a complete tear of the Achilles tendon is NOT usually painful after the first few minutes.  This is because the tendon nerve fibers are severed when the Achilles is completely torn. 

 

Learn more about Torn or Ruptured Achilles Tendon Injuries here.

 

 

Achilles heel bone spur

Bone spurs are often caused by an overgrowth of calcium on the back of the foot. This condition usually causes heel pain because of continuous tugging of an irritated and inflamed Achilles tendon on the back of the heel. Spurs cause pain and can destroy the attachment of the Achilles tendon, which if left untreated, causes more serious problems like tendon ruptures and tears. 

 

Learn more about Achilles Heel Bone Spurs here.

 

 

Treatment Options for Achilles Tendon Injuries

The best and most effective time to treat any Achilles problem is when the injury or symptoms are new.  During that time, your body is still actively trying to fix the problem (tendonitis) instead of after the injury has lingered and your body has accepted this as your new norm (tendinosis).   There are a number of non-invasive conservative treatments that we typically attempt for both new and lingering injuries (with the exception of severe Achilles tears, which we will discuss later).   These treatments are effective over 90% of time when the injury is still fresh.

 

Conservative Achilles tendon injury treatments include:

  • Correction of irregular walking patterns through muscle training in physical therapy.
  • Physical therapy is also used to decrease pain and increase flexibility
  • Custom molded orthotics, which are inserted into your shoes and are made just for your individual feet. These inserts once placed inside your shoe work as shock absorbers to painful areas while improving balance and correcting foot alignment.

 

Minimally Invasive Treatment Options

 

As stated earlier, conservative treatment is effective more than 90% of the time, however, there are instances where a more aggressive option is necessary. These “minimally invasive treatments”, which do not require surgery, include:  

 

Platelet Rich Plasma (PRP)

PRP injections are used to treat both Achilles tendonitis and Achilles tendinosis. PRP is an in-office procedure where we use your use growth factors in your own blood to facilitate an inflammation process in the injured tissue that increases the healing response.

 

Topaz radiofrequency energy therapy

In cases with continued scar formation, Topaz radiofrequency energy therapy may be used to break up the scar tissue and bring new blood to the area. This basically changes the chronic problem (tendinosis) back to a new and acute problem (tendinitis) that can be healed in a controlled environment.  After a Topaz treatment, you will be placed in a boot and be on crutches for a several weeks.

 

Tenex for Achilles Tendinosis

A new technique called Tenex has also shown great benefits in Achilles tendinosis cases.  A microscopic incision is made and the scar tissue and damaged tendon are broken up and extracted by the Tenex probe.  This changes the environment of the tendinosis, from one of poor circulation with scar tissue to good circulation and healthy tissue, which can then heal itself.  A boot is usually used for about 2 weeks.

 

Surgical Treatment Options for an Achilles Tendon Injury

 

Achilles tendonitis surgery is rare

In a small number of cases, however, the calf muscle is found to be very tight and as the Achilles gets stretched, it gets irritated and swollen. It may then be necessary pain to perform a lengthening of the calf muscle to decrease stress on the Achilles tendon.

 

Achilles tendonosis surgery

Though not common, Achilles tendonosis surgery is sometimes needed. Tendonosis, by its very nature, causes a lot of micro-traumas to the Achilles tendon over time, resulting in scar tissue. The outcome is a thickened, damaged and scarred tendon, which can be enlarged and very painful. In this instance, the tendon needs to be cleaned up and scar tissue removed surgically to allow the Achilles tendon to heal and function properly.

 

Foot and heel spurs may require surgery

To relieve the tension and stress that the Achilles tendon is placing on the area of the heel spur surgery can be the right choice. The key to a good outcome of heel spur removal is a solid reattachment of the Achilles tendon and complete removal of scar tissue and bone spurs. This is done by splitting the Achilles tendon in the center, cleaning up all scar tissue and reattaching the Achilles tendon to the bone with solid anchors.

 

Achilles tendon tears and ruptures usually require surgery

Because the tendon ends are fully torn and the Achilles does not function it often requires surgery due to the gapping of the tendon ends and lack of proper tension in the tendon.  During surgery, the torn ends of the Achilles tendon are brought together. It is rare to have to augment the repair of the Achilles as then tendon can be pulled together fairly easily. But, If the injury has been left untreated long enough and the ends cannot be united, a donated cadaver leg muscle is placed into the heel at the attachment point of the Achilles tendon to help with Achilles strength.

 

Browse our before and after pictures of Achilles tendon surgeries here.

 

 

Why Choose UFAI's Podiatrists to Treat your Achilles Tendon Injury?

 

Achilles repair procedures are complex surgeries, the doctors at University Foot and Ankle Institute have extensive knowledge and expertise in Achilles tears and their treatment. New technologies that include special hardware, that we helped develop in partnership with several manufacturers, along with advances in graft material. These new technologies and treatments have led to dramatic advances in the reconstruction of Achilles tears.

 

Our goal is to get you back on your feet in the shortest amount of time.  Schedule your consultation today!

 

 

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