ACHILLES TENDINOSIS (DEGENERATIVE TENDINOPATHY)
Previously referred to as tendonitis, tendinosis, or tendinopathy, this condition is properly called a degenerative tendinopathy. This term is used because it is a chronic condition associated with gradual degeneration of the Achilles tendon. Degeneration of the Achilles tendon results from disruption of the blood supply to the tendon, which is needed to keep it healthy and alive.
There are times when the Achilles tendon does not function correctly due to multiple, minor microscopic tears of the tendon and the limited ability of the tendon to heal or repair itself. The blood circulation to the Achilles tendon in some patients is not always as good as it should be and microscopic tears begin to occur inside the tendon, 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 becomes quite painful.
Diagnosis
It is easy to diagnose this condition. It usually occurs in patients who are between 35-45 and patients who are not necessarily athletic. The tendon and leg are painful and pushing off the leg may be painful and weak, as the Achilles tendon is thickened/swollen.
Treatment
The treatment of this condition is difficult because there is very limited potential for the tendon to heal secondary to the lack of circulation to the chronically worn out tendon. Nonetheless, there are patients who can manage without surgery, and even though the tendon remains chronically abnormal, it may not be painful.
The treatment begins with a very carefully designed program of stretching, a specific type of physical therapy, and a specially designed boot or a brace with a heel lift to rest the Achilles tendon. If pain and weakness continue after prolonged immobilization, then surgery is necessary to repair and reconstruct the degenerated Achilles tendon. Treatment is unfortunately not always successful without surgical intervention.
The surgery is not always predictable 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 or the patient is over the age of 50, a tendon transfer using the long flexor tendon to the great toe (FHL tendon) is performed. Sometimes this is supplemented with a tissue allograft (graft jacket) to aid in tendon healing and strength.
The surgeons of Cambridge Foot & Ankle have years of experience with the procedures used to treat this condition, giving you the best chance at a successful outcome.
CONDITIONS
