What is Achilles Tendinosis?
Achilles tendinosis is a condition characterized by painful thickening of the Achilles tendon. There is usually no redness or warmth of the surrounding soft tissues, although the area can be painful to touch. Achilles tendinosis is a chronic problem, meaning it develops gradually and lasts a long time. When seen under a microscope, inflammatory cells are not present, although chronic damage and microscopic tears of the tendon may be seen. Thickening of the Achilles tendon is also referred to as degenerative tendinopathy and can lead weakening and rupture of Achilles tendon.
Thickening of the Achilles tendon (Achilles tendinosis) usually occurs approximately six-centimeters from the attachment on the heel bone. Because of poor blood supply, the ability to heal these microscopic tears is limited and tearing of the tendon continues. Eventually, the tendon begins to thicken and weaken, and gets quite painful.
Causes of Achilles Tendinosis
- Lack of routine stretching of Achilles tendon
- Activities that involve sudden starts and stops and repetitive jumping
- Sudden increases in activity level
- Decreased recovery time between exercise bouts
- Training on poor surfaces or up hills
- Changes in surface, i.e. running on trails vs. concrete sidewalks
- Switching from high heel to athletic shoes
- Poor footwear, i.e. high heels
Diagnosis of Achilles Tendinosis
- Usually occurs if individuals who are between 35-45 years of age who are not necessarily athletic
- Achilles tendon is painful when palpated
- Pushing off with the leg is painful and/or weak
- Achilles tendon is swollen and visibly thickened
Treatment of Achilles Tendonosis
It is important to note that because Achilles tendinosis lacks inflammation, treatments that are aimed at controlling inflammation are unlikely to be helpful. Therefore, while anti-inflammatory medications and ice application may be used to treat symptoms of discomfort associated with Achilles tendinosis, they are not fighting inflammation in this situation.
The more effective treatments for Achilles tendinosis are
- shoe inserts (Orthotics)
- Stretching of Achilles Tendon
- Physically therapy
- Massage therapy
- Topical pain relieving gel
Surgical Treatment of Achilles Tendinosis
Since the tendon has deteriorated, and it may not be possible to get it to heal again. The deteriorated portion of the tendon is removed (debrided), and the healthy sides of the tendon are stitched together. If the extent of the degeneration is severe, a tendon transfer is performed.
Achilles Tendinosis MRI: