Article by Dr. Misako McLeod, DPM
The achilles tendon is the large tendon which connects the calf muscle to the back of the heel. It helps one during push-off during gait, running, and jumping.
Injuries and chronic inflammation (tendonitis) are common problems and, most of the time, can be easily treated with immobilization, physical therapy, anti-inflammatories, icing, and MicroVas.
When the achilles tendon become inflamed one may experience difficulty walking, tightness, and cramping at night. If the inflammation continues for long periods of time, sometimes the tendons will begin to weaken and degenerate, and start to form a bulbous mass called tendonosis. Since this represents a chronic condition, I will often recommend obtaining an MRI to fully assess the condition of the whole tendon and to evaluate for tears in the tendon.
If the tears are detected and are small, usually immobilization and physical therapy will alleviate the problem. Sometimes, stem cells are an option and can be injected into the tendon to help facilitate the healing process.
When the tendon is degenerating and the condition is chronic also know as “tendonosis”. I may recommend a minimally invasive procedure called Topaz coblation procedure. Here is a video demonstrating the Topaz technique from the Weil Foot and Ankle Institute.
If the tears are long and extensive in nature, then open surgical repair may be indicated. This involves surgery under general Anesthesia where the tendon is repaired and sometimes wrapped with amniotic (stem cells) to speed healing and prevent scar formation. Sometimes, if there is a”bump” on the back of the heel, also known as a Haglund deformity or “Pump Bump” (because it usually irritates the back of the heel in women wearing pumps) this bump can be shaved off and smoothed. The achilles tendon is the reattached.
If the patient has a tight calf muscle called Equinus, sometimes it’s necessary to lengthening the aponeurosis to better allow the heel to touch the ground. This procedure can be performed open or as an endoscopic gastrocnemius procedure.