Achilles Tendinitis
(Part 6)
Extracorporeal Shockwave Therapy (ESWT)
This therapy uses either low- or high-energy shockwaves applied to the Achilles tendon to promotehealing of the damaged tendon tissue.
*High-energy ESWT can be done in one visit but requires local or general anesthesia.
*Low-energy ESWT consists of 3 to 4 sessions and does not require local anesthesia.
Recent studies have shown improvement in pain and function with ESWT, especially when combined with other nonsurgical treatments such as eccentric exercises.
However, more information is needed before strong recommendations can be made for its routine use.
One benefit of ESWT is that it is low risk and has few to no complications, so it may be another option to consider before undergoing surgery.
Surgical Treatment
Surgery for Achilles tendinitis should be considered only if the pain does not improve after 6 months of nonsurgical treatment. The specific type of surgery depends on the location of the tendinitis and the amount of damage to the tendon.
Debridement
Debridement is a term that refers to the removal, or “cleaning up,” of damaged tissue. For insertional Achilles tendinitis, removal of the bone spurs from the heel in addition to the damaged tendon tissue is commonly performed with good outcomes. Once the unhealthy portion of the tendon is removed, the remaining tendon can be reattached to the heel bone. Metal or plastic anchors as well as strong stitches may be placed into the heel bone to help hold the tendon in place.
After debridement and repair, most patients are allowed to walk in a removable boot or cast within 2 weeks, although the timeline depends on the amount of damage to the tendon.
In cases where more than 50% of the Achilles tendon must be removed, the remaining portion of the tendon is not strong enough to function alone. Another tendon must be transferred in order to restore the strength to your foot for pushing off the ground. The tendon that helps the big toe flex down (the flexor halluces longus [FHL] tendon) is most commonly used. This tendon is removed from the bottom of the big toe and reattached to the heel. After this surgery, the big toe is still able to move, and most patients do not notice a change in the way they walk or run.