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Achilles Tendonitis/Tendinopathy

    • The Achilles tendon connects the calf muscle to the heel bone and is the largest tendon in our body. This tendon controls lower leg movement when you walk, run, jump and stand up on your tiptoes. Achilles tendonitis is a common condition that occurs when this tendon becomes irritated or inflamed after overuse from high impact activities such as running and jumping.

    • Achilles tendinopathy occurs when the tendon develops microscopic degeneration as a result of chronic damage over time. Most Achilles tendon injuries are a result of gradual wear and tear.

    • Symptoms for Achilles tendinitis/tendinopathy can include pain and stiffness over the back of the heel. Pain often is typically worse in the morning or at the end of the day and makes walking difficult. There can be swelling and warmth of the tendon.

    • Diagnosis is based on detailed history, physical examination, and imaging. The location of pain while palpating the area is useful for distinguishing between an insertional or mid portion Achilles injury.

    • X-rays can be useful in identifying bone spurs that may form with Achilles tendinitis. An magnetic resonance image (MRI) is often not necessary to diagnose Achilles tendon injuries, as diagnostic ultrasound provides detailed imaging of the tendon and may be used to identify tendon abnormalities.

    • Conservative Management
      • Initial treatment of Achilles tendonitis consists of rest, ice, NSAIDs, and physical therapy. Nonsteroidal anti-inflammatory drugs (NSAIDs) are used for pain relief and physical therapy may be utilized to improve strength and function.

    • Shockwave Therapy
      • Shockwave therapy may be used as an adjunctive therapy for chronic Achilles tendon pain. Shockwave therapy initiates the body’s natural healing process with the aim of reduction in pain and increase in function.

    • Platelet Rich Plasma (PRP) Injections
      • PRP therapy concentrates the growth factors in your own blood, which can decrease inflammation, improve function and control joint pain. In the treatment of chronic Achilles tendon injury, we use a patient’s own platelets or stem cells to help accelerate healing and promote tissue regeneration of the Achilles.

    • Stem Cell Injection
      • Stem cell injections use your own cells to stimulate the growth of healthy tissue within the Achilles tendon to improve pain and function.

    • Ultrasound Guided Needle Tenotomy (TENEX)
      • Tenex is a minimally invasive procedure that can help eliminate chronic Achilles tendon pain by precisely targeting and removing damaged tissue stimulating the healing process without the need for conventional surgery.

    • Surgical Intervention
      • In most cases of Achilles tendinitis, nonsurgical treatment options will provide adequate pain relief, although it may take a few months for symptoms to completely subside. When these noninvasive treatment options fail after at least 6 months, surgical options can be considered. The type of surgery that will be recommended will depend on the location and amount of damage to the tendon.

Silbernagel KG, Hanlon S, Sprague A. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy. J Athl Train. 2020 May;55(5):438-447. doi: 10.4085/1062-6050-356-19. Epub 2020 Apr 8. PMID: 32267723; PMCID: PMC7249277.