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Midsubstance tendonitis leads to pain along the course of the Achilles tendon. This can cause swelling or even a lump to form within the tendon. This is a condition called tendinosis. Lumps with degeneration usually have a poor prognosis with conservative treatment. This can be determined by ultrasound.
Anti-inflammatories and physical therapy are very effective with improving symptoms. Chronic pain unresolved with therapy can usually be managed by a period of immobilization. Extracorporeal shockwave therapy can also be effective. Surgery is indicated if conservative treatment fails. Surgery is commonly reserved for patients that develop degeneration within the tendon. This includes debridement of the tendon and grafting if necessary.
A rupture of the Achilles tendon occurs with an abrupt pull of the tendon. This can occur when lifting a heavy object or in events that lead to abrupt starts and stops, such as tennis or basketball. A rupture is more common in middle aged individuals. Studies show that the tendon may have some degeneration prior to rupture. Individuals commonly feel a “pop” in the back of the tendon. There may not be immediate pain. Complete ruptures are easy to diagnose clinically and with diagnostic ultrasound. Partial ruptures are less obvious clinically, but can easily be diagnosed with diagnostic ultrasound.
Partial ruptures can be treated with a period of immobilization. If this fails, then surgery is indicated. Complete ruptures are best treated surgically. This allows the fastest recovery with the least amount of muscle atrophy. Patients can often begin ambulating within a week following the procedure.
Early treatment includes rest, ice, and anti-inflammatories. If this fails, then a cortisone shot, physical therapy, or immobilization may be necessary.
Surgery is indicated if conservative treatment fails. New anchor systems and sutures allow for much faster recovery.
Insertional Achilles tendonitis is when the tendon gets inflamed at the attachment in the heel. It is theorized that overuse can lead to micro tears in the tendon fibers. The bursa between the tendon and bone can also become inflamed. This leads to swelling and pain, especially when walking or running. Many individuals also develop a spur which can lead to pressure pain in the back of the heel. A fracture of the spur can occur on rare occasions.
The Achilles tendon is the largest and strongest tendon in the body. It is the conjoint tendon of the gastrocneumius and soleus muscles. The Achilles tendon inserts into the posterior heel bone. It is primarily responsible for lifting the heel off the ground during the gait cycle. This repetitive cycle, especially when active, can lead to overuse or even rupture.