Chronic Achilles Tendon Pain

The Achilles tendon may develop a degenerative condition within the substance of the tendon. Similar to scar tissue, it can lead to significant pain, swelling and weakness as well as difficulty with everyday activities and sporting activities including running.

Pain often exists along the back of the heel, and a painful thickened tendon may be present. Any pressure on this area may reproduce the pain and stiffness commonly experienced. The scar may occur within the substance of the tendon above the level of the heel or may occur at the level where the tendon inserts into the heel bone (insertional Achilles tendonitis).

Chronic Achilles Tendon Treatment

The location of the swelling and degenerative change helps define the surgical treatment options and necessary interventions if conservative treatment fails. There is a theoretical increased risk of rupture of the Achilles tendon when pre-existing tendonosis is present within the Achilles.

Non Surgical Treatment for Chronic Achilles Tendon Disorders

Conservative treatments involve a stretching program with or without physical therapy, heel lifts and/or footwear modifications, as well as icing the Achilles and heel region, wearing open heeled shoes that do not cause irritation of the tendon or the heel bone, occasional immobilization in a boot for severe acute irritation, and other conservative measures. If this approach to treatment fails, surgical treatment may be necessary. Not all Achilles tendon problems can undergo the same surgical treatment and thus the location of the abnormality, degree of tendon involvement, and location of involvement define the appropriate treatment options.

Surgery for Chronic Achilles Tendon Disorders

The simplest surgical treatment involves a limited debridement and coblation of the Achilles tendon. The procedure involves cleaning out the diseased tendon partially and using thermal energy to create a localized debridement of the tendon to stimulate the body to heal the tendon. This procedure can often be performed under local anesthesia only, with mild twilight anesthesia occasionally necessary in addition.

A one centimeter incision (approximately one-third of an inch) directly over the diseased tendon is utilized and the tendon is treated. After surgery, the swelling over the tendon may persist but the pain associated with the tendon scarring is often reduced significantly. Recovery involves two weeks of non-weight-bearing and immediate motion of the ankle is encouraged with a gradual increased progression in activity.

When the limited approach has failed in the past or in the case of more extensive degenerative change of the Achilles, a more extensive surgical debridement (clean-out) of the Achilles tendon scarring and repair (with or without an additional tendon transfer to augment the strength of the Achilles) may be necessary. This procedure allows for a more reliable removal of the diseased tendon and likelihood of pain relief, but the recovery period longer.

Chronic Achilles Tendon Disorder Pain Relief in Chicagoland

If you’re experiencing pain from a chronic achilles tendon disorder, please fill out our contact form or call 847-247-4000 to schedule an appointment.

For more information on these injuries and their treatments please see: