Achilles Tendinosis Surgery

What is Achilles tendinosis?

When the Achilles tendon degenerates and become inflamed, the condition is called Achilles tendinosis.  The tendon can swell and may cause pain. This condition is common in athletes, runners and patients who have calf tightness. Achilles tendinosis may occur in the middle of the tendon. This is known as midsubstance Achilles tendinosis. It may also occur at the point where the tendon connects to the heel bone. This is known as insertional Achilles tendinosis.

What are the goals of Achilles tendinosis surgery?

For midsubstance Achilles tendinosis, procedures have focused on removing the bad portion of the tendon. If most of the tendon is damaged, surgeons will often use the tendon that goes to the big toe to support the Achilles tendon after repair. Other procedures may include lengthening the Achilles tendon or calf muscles if they are too tight.
Surgery for insertional Achilles tendinosis is similar. Very often the diseased tissue is removed and then the tendon is repaired back down to the heel bone. Surgeons will often shave down the bone spur and smooth it out so that it no longer has the ability to rub the Achilles tendon. There is often a fluid filled sac (bursa) that contributes to the pain and inflammation. This bursa is frequently removed during the surgery.

What signs indicate surgery may be needed?

Surgery may be an option for Achilles tendinosis if other treatments, including physical therapy, ultrasound, massage and shockwave therapy, fail to bring pain relief.

General Details of Procedure

General anesthesia is commonly used. Regional anesthesia that numbs the leg may also be used. The patient is then positioned face down on the operating table.  An incision is made in the back of the ankle directly over the Achilles tendon. The diseased portion of the tendon is removed with a scalpel. If the problem involves the end of the tendon where it inserts on the heel bone, the tendon may be lifted off of the heel bone.  The bump at the back of the bone is removed with a chisel or saw, and the tendon is repaired back down to the remaining bone. Some surgeons also perform a stretching of the calf muscles as part of the procedure. The incisions are sewn together. The leg is bandaged and then protected with a splint or boot brace.

What happens after surgery?

Recovery time is usually many months. Non-operative treatments usually take about three to six months before symptoms resolve. Often surgical patients will need several months in a protective boot and crutches before they can walk without crutches or a walker. Physical therapy is often required to help restore mobility and strength to the repaired tendon. It may take surgical patients a full year before symptoms resolve.
Patients improve with both conservative and operative management of Achilles tendinosis. Physical therapy has been shown to help most patients with this condition and should be tried before surgical management is proposed. 
Surgery can predictably return patients to activity. Success rates have been reported between 80 and 90 percent, which means that eight to nine out of 10 people improve with surgery. Some of the variability depends on the amount of tendon that is diseased at the time of surgery. 

Potential Complications

There are complications that relate to surgery in general. These include the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots.
After this surgery, patients can still have moderate pain. If the tendon is repaired there is still risk of future degeneration of the tendon as the patient ages. However, repeat surgery is rarely required. 

Frequently Asked Questions

If I am treated without surgery for Achilles tendinosis will it come back?
While most patients will achieve lasting relief after treatment for Achilles tendinosis, symptoms may return. The risk decreases if the patient continues to do routine stretching even after the symptoms resolve. However, athletes and runners in particular are at a slightly higher risk for this condition because of the high demands on the Achilles. These patients should pay close attention to stretching, and shoewear to prevent chronic recurrence. 
Will I still have pain after surgery?
Eight to nine out of 10 patients improve after having surgery. However, up to two to three out of 10 patients still do have some pain even after appropriate surgical treatment. 
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