Achilles tendonitis comes about through overuse injury to this large back-of-leg tendon connecting to the heel. It can come about without a history of trauma and is most common in athletes, especially long distance runners. Inflammation and degeneration are caused by repeated stress. Over-pronation, where a collapsed arch puts pressure on the Achilles tendon can be causative. If left untreated, it may lead to a rupture.
Pain is often worse after a period of inactivity such as sleep or sitting for a long time. The pain can be described as piercing, shooting or burning and is felt most intensely in the heel area where the tendon attaches. The tendon will be swollen and tender to touch.
Rest is the first line of defence to allow the inflammation to settle down. Athletes who are unwilling to give up their training regime are encouraged to adopt more stretching to warm up their muscles, to cut down on the length of runs, avoid uphills and use ice packs after exercise.
Orthotic devices can be used to combat overpronation and support the arch. A lightweight, shock-absorbing heel cup will reduce stress on the Achilles tendon by elevating the heel. Advice is always given to give up smoking as this delays the repair of tissues by decreasing the blood supply. The focus is on non-surgical options for most patients.
The majority of patients with Achilles tendonitis do not need surgery. However if the Achilles tendonitis persists despite physiotherapy and other non-operative measures including insoles and anti-inflammatories, then surgery may be effective in getting rid of the problem. A decision to undergo surgery is based on an evaluation of the problem including a thorough examination and investigations, which will include an MRI scan or ultrasound scan. Beyond that, a consideration of all the options and the pros and cons of surgery at the consultation would be undertaken, in order to allow you to make what you feel is the right decision regarding your complaint.
The operation is fairly simple to perform. It involves making a cut in the skin over the tendon. Any thickened lining of the tendon is taken away and small incisions are made in the tendon to encourage healing. Following an operation, a plaster is not usually needed. If however more work has been done on the tendon because of the state of the tendon then a plaster or a walker boot may be needed for a few weeks following the surgery.
Surgery for Achilles tendonitis is generally quick and takes approximately twenty to thirty minutes.
Surgery for Achilles tendonitis is usually carried out as a day case.
It is usually possible to get back to work following surgery for Achilles tendonitis by two weeks. The back of the ankle may be sore for a period of time following surgery and this would need to be taken into consideration with regard to driving. Generally, in the first six weeks, a more sedentary type lifestyle is required with regard to work. For more manual work return to work at approximately two months would be reasonable. In the interim amended duties and or altered hours may allow you to return to work. Return to playing sports is usually at about three months following surgery for Achilles tendonitis.
Following surgery for Achilles tendonitis physiotherapy is needed to rehabilitate the ankle and to maintain strength. Usually, between six and ten sessions of physiotherapy are needed following surgery for Achilles tendonitis.
All surgery carries risks and this includes surgery for Achilles tendonitis. There is a risk of infection, deep vein thrombosis, clots in the legs or lungs, nerve or vessel injury and complex pain. A full discussion of the risks will take place at the consultation as it is part of the decision-making process, as well as consideration of the other treatment options.