Q&A: How successful is chronic Achilles tendonitis repair?

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How successful is chronic Achilles tendonitis repair

- Benita


Howard R. Fox, DPM, FACFS - LocateADoc.com

Well Benita, as you may already know, Achilles tendonitis is an inflammation of the Achilles tendon, usually one discrete portion of the tendon, and typically an inch or two above the ankle.  Technically, it’s the joint fluid between the tendon and the tendon sheath that’s inflamed.  The treatment is rest, wearing a heel lift, oral anti-inflammatory medication and physical therapy, usually in the form of gentle stretches, ice massages and even acupuncture.  Since tendons receive a relatively poor blood supply, they take a long time to heal.  In very stubborn cases when nothing seems to work, the patient is placed in a below-knee cast with the foot angled down, off-weight bearing, to completely rest it for several weeks.
Surgery is very rarely necessary for this, and if you’ve had all this and are contemplating surgery because nothing seems to be working, I’d first make absolutely certain you only have an Achilles tendonitis, and not a partial tear of the tendon or irritation from a bone spur.  A good diagnostic ultrasound or an MRI would detect this if the “slices” obtained are thin enough (3 mm or less).  If this involves both feet, you should be worked up for an underlying arthritic condition that can present as Achilles tendonitis before contemplating surgery.
To specifically answer your question, the success of the surgery depends on what kind of surgery you’re going to have.  If there is a shortening of the Achilles tendon and the pull on it needs to be reduced, the preferable procedure is something called a gastrocnemius recession, where the calf muscle is lengthened.  The recovery from this is far faster and better than lengthening the Achilles tendon directly, since, like I mentioned, tendons have a poor blood supply and take longer to heal than muscle, which has an excellent blood supply.  If shortening is the cause of your tendonitis, gastroc recessions are very successful.  If the tendon itself is just being “cleaned up” (releasing the tendon from its sheath and removing any fibrosis, calcium or thickened tissue), the success rate is about 70%.  While a 70% success rate is a lousy success rate for surgery, I believe the main reason it’s as low as this is because there are a number of patients who have this surgery when they aren’t properly diagnosed and worked-up and there is a tear or underlying arthritic disease or a tightness of the tendon which wasn’t also address, so it tends to come back.  If the patient is properly worked up and the diagnosis is accurate, the success is in the high 90’s.
When in doubt, get a second opinion.  It’s a stubborn problem, and I know this first-hand, since I’m dealing with a low-grade Achilles tendonitis myself now for a few years.
Best of luck to you!!!

--Howard R. Fox, DPM, FACFS
Staten Island, NY

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