Achilles tendonapathies are very common and can be difficult to treat conservatively. The tendon begins to degenerate and becomes inflamed and painful. The condition is common in athletes, runners in particular and often presents in patients who have marked calf tightness. Achilles tendinosis may occur in the middle of the tendon (mid substance Achilles tendinosis) or can occur at the point where the tendon connects to the heel bone (insertional tendinosis).
For mid substance Achilles tendinosis the surgeon removes as much as the damaged part of the tendon as possible. The extent of tendon damage then determines how the surgery proceeds. If a lot of the Achilles is removed it may need to be reinforced using another tendon which can be harvested locally in the foot. Other procedures may include lengthening the Achilles tendon or calf muscles if they are too tight.
Surgery for insertional Achilles tendinosis is similar with the damaged tendon being removed completely from the heel and then anchored securely back down. Surgeons will often prepare the heel bone by shaving any excess bone formation smoothing it out as much as possible so that it no longer has the ability to rub the Achilles tendon. There is often a fluid filled sac (bursa) that contributes to the pain and inflammation. This bursa is frequently removed during the surgery.
Each patient will be put in a plaster of paris back slab for the first 10 days and will then be serially casted for the next couple of weeks until they are ready to partially weight bear (walk in a boot) at 6-8 weeks.