Achilles tendinitis is a common cause of posterior heel pain. Patients who have this often also have had plantar fasciitis in the past. This is because the cause is similar. Fortunately, many cases are able to be treated without surgery.
The Achilles tendon is the largest tendon in the body. Tendinitis is inflammation of this tendon, which can be caused by overuse, shoe rubbing, inflammatory disorders, a particular shape of the heel bone, and tight calf muscles. The body responds to micro-tears in the tendon by laying down calcium deposits, which are commonly called “bone spurs.” The calcium is not the painful portion of the disease but is a helpful sign on x-rays to signify chronic injury to the tendon. Gradually, the normal collagen and elastin of the tendon are replaced by scar tissue.
Achilles tendinitis can be persistent. Nonoperative treatment may take nine months to a year to be effective. However, many patients do improve and never go on to need surgery.
Radiofrequency is the newest technology used for Achilles tendinitis. In the past, invasive radiofrequency has been performed in the operating room, which leads to weakening of the tendon, scarring of the skin, bleeding, and risk of infection. The Cynosure radiofrequency is completely non-invasive and carries fewer risks from treatment. This is treated in three sessions.
Radiofrequency helps to decrease muscle spasm and loosen the calf muscle to allow for more effective stretching, as well as aid in pain relief. It stimulates the production of collagen and elastin, which are necessary for normal tendon health.
Surgery for insertional Achilles tendinitis is only done after the pain persists despite a prolonged course of nonoperative treatment. In most cases, the surgery requires complete detachment of the Achilles tendon, removal of the bony prominence, and reattachment of the tendon. For the tendon to heal back to the bone, the foot has to be immobilized in a cast for 6 weeks with the toes pointed downwards, generally without being able to walk on it. The foot is gradually brought to a neutral position and physical therapy is started after the cast is removed.
Physical therapy is crucial to recovery after surgery. The most serious risk in this surgery is infection of the wound or detachment of the tendon; both of these are attributed to the poor blood supply to this region. For this reason, surgical candidates should minimize their risk of such complications by smoking cessation, weight loss, and good compliance with post-operative protocols.
What Not To Do
Summary of Treatment
- Calf stretches
- Silicone heel lift
- Physical Therapy
- Non-invasive radiofrequency
- Surgery, only when all else fails