Pain and swelling at the back of the heel or about the Achilles tendon, could be the result of tendinosis, a common degenerative condition.

Unlike tendinitis, which is an inflammatory disorder confined to the tissue surrounding a tendon, tendinosis affects the tendon substance and is a deterioration in structural integrity with a ‘breakdown” of tissue quality. It can occur where the tendon inserts to the heel bone (calcaneus) or within the mid-substance of the tendon, halfway between the heel and the calf muscle.

Tendinosis is common in overweight, sedentary and diabetic people, but is also frequently precipitated by changes in an otherwise healthy person’s activity profile. Smoking and certain medications can also contribute. Episodes of micro-trauma within relatively de-conditioned tendon can, over time, lead to an accumulated injury effect with a gradual deterioration in tendon structure and function. This can produce pain, which is typically at its worst when rising from a chair or from bed in the morning, or during longer periods of weight-bearing activity, in association with local swelling and tenderness.

Xrays of insertional disease frequently show the tell-tale signs of chronic (long-standing) tendinosis with a “spur” at the tendon attachment which can extend upward within the tendon itself, often together with separate calcification or ossification (bone formation). There can be evidence of the top corner of the heel bone rubbing against the front of the tendon. An MRI assessment is often required to provide more-detailed information about the condition of the tendon and to guide management decision-making.

Initial treatment is usually non-operative and includes addressing lifestyle issues, such as obesity, lack of regular exercise and cigarette smoking, and introducing footwear modification and a regular sustained stretching programme. Anti-inflammatory medication can be helpful. Some patients just need to make changes to their training or exercise routines to bring symptoms under control. The involvement of a physiotherapist is often necessary.

When non-operative measures fail to have the desired effect, surgical intervention may need to be contemplated. This can involve the removal of diseased, non-functional tendon, along with extra (heterotopic) bone along with any bone that impinges (rubs) on the tendon, and there is often a need to partially detach and then reattach tendon to achieve these goals.

The good news is that most people recover well from symptoms related to their achilles tendinosis, if they adhere to treatment recommendations, although this is rarely a quick process.

  All surgical procedures involve risks. The information provided here is for general educational purposes only. For specific advice regarding Achilles tendinosis, please book an appointment with Dr Newman.

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