Achilles Tendon Problems
Why does it occur?
The Achilles tendon becomes prone to injury and pain in middle-aged people due to reduced tissue quality and blood supply. This can come on as a result of a specific injury or more chronic overuse and often presents with a painful swelling. This can be located near the insertion into the heel bone (insertional tendinopathy) or some distance away in the body of the tendon (non-insertional tendinopathy). Invariably these conditions result in difficulty with walking distance & intensity and interfere with participation in sports.
What is the treatment?
Most patients respond to anti-inflammatory medication, splintage and special stretching and/or strengthening exercises (eccentric loading), but occasionally surgery to remove abnormal tissue from the tendon is required. Usually the normal tendon can be preserved (repaired) in this procedure, but in longstanding cases with extensive tissue damage a tendon reconstruction or transfer is necessary prolonging the postoperative rehabilitation.
What about Achilles tendon ruptures?
Acute tears of the Achilles tendon often occur as a result of sport activities and can be treated successfully both with and without an operation in many patients. In athletes and other very active patients, who are keen to return to sport activities, surgical repair can lead to a slightly better outcome but the benefits and risks need to be balanced with each other. Minimally invasive repair techniques can allow patients to rehabilitate and return to activities more quickly. Occasionally the diagnosis is missed early on and the patient presents late. Treatment is then along the lines of chronic Achilles pain outlined above.