- Although pain can be felt along the entire course of the tendon, it is generally encountered at the insertion of the tendon into the heel bone (calcaneus) or approximately 2-3 cm above the insertion
- Pain is usually worse 1st thing in the morning or when walking after a period of rest (post-static dyskinesia). Pain is also felt when walking up and down stairs or up and down an incline
- Thickening of the tendon
- Tenderness along the tendon
- Prominent bone at the insertion of the tendon into the calcaneus
Diagnosis is made by a comprehensive foot and ankle exam by Dr. Stewart along with x-rays of the foot. Imaging studies such as ultrasound and MRI are sometimes required to determine the extent of tendon injury.
Achilles tendinosis generally takes 6-8 weeks to improve and early activity on a healing tendon can result in a setback in recovery. Non-compliance can double the recovery time and can be very frustrating for patients.
Early and aggressive conservative treatment is recommended to prevent further tendon injury. Dr. Stewart terms Achilles tendinosis a pro-active condition. Conservative treatment includes and is not limited to immobilization, stretching, icing, physical therapy, and therapeutic laser. Although we can never offer a 100% guarantee, the majority of Dr. Stewart’s patients improve with conservative (non-surgical care).
I would absolutely recommend Timonium Foot and Ankle, Dr. Stewart and his staff to anyone. I want to give them all a HUGE Thank You!!!”
Conservative treatment for Achilles tendinosis includes:
- Immobilization of the foot and/or ankle. Depending on the severity of the condition, this may require cast immobilization with crutches, a walking boot, a hinged ankle foot orthosis with supportive shoe gear, a multi-ligamentous ankle brace with supportive shoe gear, or custom foot orthotics with supportive shoe gear
- Modification of physical activity including avoidance of walking, jogging, running, and the elliptical for exercise; recommended exercises include circuit training, swimming, and bicycling
- Stretching and strengthening exercises with a Theraband
- Compression therapy generally with prescription compression stockings
- Therapeutic laser
- Physical therapy
- Weight loss and dieting
- Medications including anti-inflammatory medications (NSAIDs), Tylenol, oral steroids, and in some cases narcotic pain medication
- Ice along the tendon 2-3 times per day for 20 minutes at the area of maximum tenderness. Elevation is recommended while icing
- Avoidance of flip-flops, flats, and barefoot walking
- Supportive shoe gear including a motion control running shoe such as Brooks, Asics, New Balance, or Saucony. Keen and Merrell style shoes are also recommended
- Custom foot orthotics
- Night splint to help stretch the tendon
If all conservative intervention fails, then surgical intervention maybe required. Dr. Stewart will determine which procedure is best for you.
Surgical treatment for Achilles tendinosis includes:
- Tendon debridement and repair
- Tendon grafting
- Debridement of tendon and bone with reattachment of tendon to bone with bone anchors
- Tendon lengthening