Chronic Achilles Tendonosis

Dr. Baravarian discuss the difference between Achilles Tendonitis, tendonosis and a rupture.

University Foot and Ankle Institute’s physicians specialize in Achilles injury treatment, from minor inflammation to severe tendinosis requiring surgery. 


While we always take a conservative approach to treatment, rest assure that we are experts in the advanced technology treatment options. Not only were we one of the first organizations to use Topaz technology and many of the other advanced treatments, we helped develop them.


Our decades of experience with the most advanced treatment options available gives our patients the highest success rates in the nation.

What is Achilles Tendinosis?

Achilles Tendinosis often occurs when Tendonitis (an acute inflammatory condition) isn't properly treated. It continues to worsen due to the continued stress and strain.


Tendinosis is when the condition becomes degenerative and the tendon then thickens with scar tissues and partial tearing may occur.


What are the Symptoms of Achilles Tendinosis?

Chronic, Achilles Tendonosis, university Foot and Ankle Institute
UFAI's Dr. Baravarian discusses chronic Achilles tendon injuries in Podiatry Today.

Achilles tendinosis is a chronic condition, meaning that symptoms have been present for more than a few weeks. The condition is usually not the result of a direct injury but rather a slow progression over time.


Patients often describe pain with activity (especially those involving climbing stairs, running or jumping) and discomfort after extended periods of rest. There is often no warmth or redness in the injured region, although it may be painful to the touch. Some patients report a bump in tendon.


Treatment Options for Achilles Tendinosis

As is the case with most chronic tendon conditions, scar tissue begins to build up and over time the body begins to give-up healing the damaged tendon. The goal of Achilles Tendinosis treatment is to supply blood to the damage tendon, which prompts the healing process. Because inflammation is not present in cases of tendinosis, anti-inflammatory medications will not treat the condition, however they may be used to ease discomfort.


Conservative Treatments

  • Physical therapy and stretching to break down scar tissue and increase the blood supply to the damaged region
  • Relative rest: substitute high impact exercises with those that are easier on the tendon (swimming, moderate biking, etc.)
  • Orthotics to correct any misalignments
  • Bracing or walking boot to protect the tendon


Minimally Invasive Treatments for Achilles Tendinosis

Platelet Rich Plasma Therapy (PRP)

A sample of the patient’s blood is drawn and a concentration of platelet rich plasma is removed. These platelets have a high concentration of growth factors, and when injected in the damaged area they signal to the body to begin healing.

Read more about Platelet Rich Plasma Therapy.


Tenex Procedure

This procedure uses the Tenex probe for the precise, microscopic removal of the damaged tissue. As scar tissue is broken up, bloody supply to the area is increased which prompts healing. Generally a boot is worn for 1-2 weeks following the procedure and return to activity is much quicker than with open surgery.

Read more about the TENEX procedure.


Topaz Procedure

Microscopic holes are made in the damaged soft tissue of the tendon. The TOPAZ wand is used to send radio-frequency energy that breaks up scar tissue and increases blood supply to the tendon and relieving pain in the area. The increased blood supply spurs healing in the damaged tendon. Downtime is limited and generally a boot is worn for 2-3 weeks following the procedure. 

Read more about the TOPAZ procedure.


Shockwave Therapy

This non-invasive procedure delivers small, controlled, low-energy shockwaves that cause micro trauma to the damaged tissue. This initiates the healing response, allowing new blood vessels to form in the area and signals more growth factors and nutrients to the area.

Read more about Shockwave Therapy.



This non-invasive procedure uses radiofrequency technology to safely heat and warm the tendon. This deep healing of the tendon stimulates the body to send growth and healing factors to the treatment area. Patients are in a boot for 2-3 weeks following the procedure. 

Read more about the RELEF procedure.


Stem Cell Injections

Stem cells can be used to help regenerate tissue that is damaged. Stem cells are harvested from the patient’s body and injected back into the tendon so that they can help rebuild the tendon. 

Read more about Stem Cell Injection Therapy.


Achilles Tendinosis Treatment, Achilles Tendonosis

Surgery for Achilles Tendon Repair

Occasionally, damage to the Achilles is so severe it doesn’t respond to any non-surgical treatment options. In these rare cases, Achilles surgery is be needed to remove scar tissue and repair the tendon allowing the it to heal properly.


This surgery involves examining the Achilles tendon intra-operatively and removing any damaged or scarred tissue that is present. This procedure may leave a defect in the Achilles that may weaken the tendon. A graft can be used to augment the repair of this tendon should the scarred lesion be big.


This surgery requires extensive rehabilitation and patients will need to be immobilized in a cast for at 4-12 weeks depending on the extent of scar tissue that was removed.


Read more about other Achilles Tendon Injuries.

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