This is the strongest tendon in the body. Achilles tendon disorders and injuries impair or prevent normal walking, running and jumping.

Achilles tendon inflammation

Achilles tendon inflammation and degeneration can affect anyone, but people participating in running or jumping sports are particularly at risk. Different parts of the tendon may be affected: half of cases involve its middle section and one quarter its distal attachment at the heel, often called Haglund deformity.

Untreated Achilles tendon inflammation can cause partial or complete rupture.

Symptoms

  • tendon thickening
  • marked tenderness at the thickened area
  • pain that increases immediately on getting up or during prolonged activity such as running
  • discomfort in shoes caused by enlargement of the distal tendon attachment, known as Haglund deformity

How is it diagnosed?

  • medical examination and symptom history
  • imaging: X-rays, ultrasound and CT (PedCAT)
  • additional MRI if necessary

Non-surgical treatment

Treatment is always selected individually according to the duration, location and severity of the condition. It includes:

  • anti-inflammatory medicines
  • reducing sporting activity
  • temporary reduction of weight-bearing and immobilisation in a special brace
  • stretching the posterior calf muscles and eccentric exercises, particularly important when the middle section of the tendon is affected
  • physical treatments such as ultrasound, iontophoresis and cryotherapy
  • shockwave therapy
  • ultrasound-guided local administration of hyaluronic acid or platelet-rich plasma

Surgical treatment

Surgery is considered when non-surgical treatment has been ineffective for at least six months. It is individually selected according to the duration, location and severity of the condition. Procedures use spinal anaesthesia, with medication administered near the spine. Surgical treatment includes:

  • removal of degenerative tissue from the tendon
  • removal of inflamed surrounding tissues, such as bursae
  • removal of excess bone compressing and irritating the tendon at its distal attachment, as in Haglund deformity
  • in selected cases, heel bone osteotomy to reduce loading on the Achilles tendon
  • in more advanced cases, reinforcement of the affected tendon with tendon grafts from other parts of the body, such as the big toe

Rehabilitation after the procedure

  • getting upright on the first day after surgery
  • two-day hospital stay
  • brace or plastic splint, walking with crutches without weight-bearing for six weeks
  • from two weeks, exercises strengthening the thigh extensor and flexor muscles
  • from six weeks after surgery, a walker boot for a further six weeks, with passive and active foot and calf exercises
  • weight-bearing exercises, jogging, swimming and cycling from 12 weeks after surgery
  • professional sport four months after surgery