Achilles Tendinosis (Degenerative Tendinopathy)
There are many different words used
to describe this condition. It has been referred to as tendonitis,
tendinosis, and tendinopathy. In this condition, the terminology
which I will use is called a degenerative tendinopathy. This term
is used because it is a chronic condition, and is associated with
gradual degeneration of the Achilles tendon. What do I mean by degeneration?
Well, the Achilles is no different from other tendons is the body.
It relies upon a blood circulation which is quite tiny, but goes
to the tendon, and keeps it alive and healthy.
There are times when the Achilles tendon does not function correctly
because of multiple, minor microscopic tears of the tendon and the
limited ability of the tendon to heal and 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 gets quite
painful.
It is easy to diagnose this condition. It usually occurs in patients
who are between 35 and 45, and who are not necessarily athletic.
The tendon and the leg is painful, and pushing off the leg may be
painful and weak. The Achilles tendon is swollen, and visibly thickened.
This can be felt with the finger as an elongation which is thickened
in the tendon.
The treatment of this condition is difficult, because there is very limited potential for the tendon to heal, due to the lack of good blood 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 either a boot or a brace
designed for treatment of chronic tears of the Achilles tendon. This
commences with various physical therapy treatments and immobilization
of the leg in a walking boot to rest the Achilles. If pain and weakness
continue after prolonged boot treatment, then surgery is necessary
to repair and reconstruct the degenerated Achilles tendon. Full and
successful treatment is unfortunately not always successful without
surgery.
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, a tendon transfer is performed. The tendon transfer is
done much like the repair for chronic Achilles rupture as described
above.
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| Here you can see the deteriorated
Achilles tendon on the left picture. There is a long split
in the tendon. The dead portion of the tendon is being removed
in the right hand picture. |
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The tendon has been repaired after removing
the dead center and stitching the tendon together |
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