What is Achilles Tendonosis?

Achilles tendonosis, also called degenerative tendinopathy, is the gradual degeneration and deterioration of the Achilles tendon. Achilles tendonosis begins with tiny tears in the connective tissue in and around the Achilles tendon. These tears, if not allowed to heal, eventually cause the tendon to lose its structure and swell. The paratenon, a covering on the Achilles tendon that provides lubrication and blood flow to the tendon, then becomes inflamed, and pain ensues.

The longest tendon in the body, the Achilles tendon, connects the calf muscle and the heel bone. Running down the back of the lower leg, the Achilles tendon sometimes is called the “heel cord.” The tendon makes it possible to raise the heel off the ground during walking.

Most often caused by overuse, Achilles tendonosis usually develops because of repeated activities or a sudden increase in activity using the tendon. The body is unable to repair the tiny tears that occur because the tendon is constantly stressed from use. This makes athletes especially prone to Achilles tendonosis. Achilles tendonosis also can occur from wearing certain types of shoes if the wearer is genetically prone to problems with the Achilles tendon.

Symptoms of Achilles tendonosis include pain within the tendon, especially after periods of rest, and difficulty walking or climbing stairs. The tendon might become enlarged, and nodules sometimes develop in the area where the tissue is damaged. Diagnosis includes evaluation of the condition of the tendon and the patient’s range of motion, along with X-rays and other imaging tools.

The treatment for Achilles tendonosis can range from home care to surgery. Immobilization is nearly always recommended, and a cast or walking boot might be used to reduce stress on the tendon while it is healing. Ice and medication such as ibuprofen is used to reduce inflammation and pain. Night splints to keep the tendon stretched, as well as physical therapy, also are used in treatment. In some instances, orthotic treatment is used, and a wedge of material raises the heel to reduce pressure on the tendon during walking.

If the condition doesn’t respond, a surgery to lengthen the Achilles tendon might be performed. Topaz radiofrequency ablation is a newer method of treatment that is used to stimulate an inflammatory reaction within the tendon and start a natural healing process. Another method of treating Achilles tendonosis is a platelet-rich plasma injection, during which the patient’s own plasma is collected and injected into the Achilles tendon to promote healing.