Achilles Tendonosis (pain with swelling)

Achilles tendonosis develops in cases of neglected pain and swelling of the Achilles tendon. If the tendon is not cared for at an early period and chronic overload of the tendon continues, the tendon eventually begins to get microscopic tears that develop into scar tissue. This results in enlargement of the tendon and scar tissue in the tendon which causes pain. If caught early, conservative measures such as physical therapy and orthotic custom insoles may be used to reverse the scar tissue and pain.

1tendonosis
Picture showing the swelling and bulbous tendon above its attachment to the heel bone. Notice the point of the scissors pointing the area of thickening of the tendon.
2tendonosis
Picture showing an achilles tendon. The foot is on the right going down and the leg is to the left. Notice the increased thickening of the tendon from scar tissue formation.

Treatment of Achilles Tendonosis

Conservative treatment can be attempted when there is tendonosis, with less probability of healing due to the chronic nature of the deformity. Immobilization and physical therapy may be attempted. In most cases, surgical correction of the tendon needs to be performed.

3tendonosisIn certain cases of chronic pain and swelling, a novel approach called Platelet Rich Plasma Injection can be used to allow for healing of the tendon. In Platelet Rich Plasma Injections therapy, the patient’s blood is collected and spun down taking out the rich healing plasma material. This plasma is then injected into the tendon and begins a healing cascade within the body that allows for removal of the poor scar tissue and healing of the tendon without the need for surgery.

The extra thickening of the tendon will need to be reduced. The scar tissue and any damaged tendon will need to be removed. With continued scar formation, Topaz coblation may be needed to break up the scar tissue and bring new blood to the area. This coblation will turn this chronic problem into a new acute problem that can heal in a controlled environment. The patient will be placed in a cast on crutches for a period of weeks. In rare cases, the tendon may need to be reinforced with another tendon by transferring a tendon to the achilles tendon.

4tendonosis
Picture showing the Achilles tendon split opened in order to reduce the thickening and remove the scar tissue.
5tendonosis
Topaz probe being used to fenestrate the Achilles tendon.
6tendonosis
Notice the pinpoint holes within the substance of the tendon.
7tendonosis
Final repair and closure of the tendon.

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