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Achilles Tendon | Ankle Arthritis | Ankle Sprains
Achilles Tendon Disorders
Achilles Tendon Pain
Pain in the Achilles tendons is a common condition. It is often seen in high performing athletes particularly runners, but often occurs in normally mobile people with symptoms often occurring in the 30’s and 40’s.
The pain is usually caused by a degenerative process occurring in the Achilles tendon, which is caused by chronic lack of oxygen due to the thickness of the tendon. Inflammation and tightness of the membrane round the Achilles tendon can also play a role in this problem as well as micro-tearing of fibres of the tendon caused by overload. Inflammation round the Achilles tendon is one manifestation of this problem as is the painful swelling of the tendon itself.
Treatment of Achilles Tendon Pain
1. Physiotherapy
In many cases physiotherapy treatment with stretching, ultrasound, massage and muscular exercises to improve the walking cycle will settle down Achilles tendon pain. Following successful physiotherapy treatment it is important to continue the stretching exercises indefinitely to maintain the condition in the longer term.
2. Minor Surgical Interventions
(a) Steroid injection
Steroid injection: This can sometimes be used when there is an abundance of inflammation around the tendon in the tendon sheath. This can be complicated by rupture of the Achilles tendon and is therefore not commonly used.
(b) Stripping of tendon sheath
Stripping of tendon sheath: This can be successful when the tendon sheath is seen to be thickened and tight on an MRI scan
(c) Coblation treatment
Coblation treatment: A minor operation is performed where a special probe is inserted into the tendon in a grid fashion. The probe emits high frequency radio waves, which alter the molecules of the tendon and ease the symptoms.
Plaster casts may not be required following these procedures. The result may take some weeks to become clear. If the procedure is not successful then a major procedure may be required.
3. Major Surgical Interventions
(a) Debridement of tendon and reinforcement with Leeds-Kieo tape
Debridement of tendon and reinforcement with Leeds-Kieo tape: The tendon is opened and the diseased portion removed. This may remove 80-90% of the tendon. The surgical tape is woven into the calf muscle above this and anchored through a drill hole in the heel. The ankle is rested in a plaster for 2 weeks in order to allow the wounds to heal and physiotherapy starts once the plaster is removed. Aim to build up to full weight bearing and movement in 4-6 weeks.
(b) Flexus Hallucis Longus Tendon
FHL transfer: The flexing tendon of the big toe is transferred to the heel to reinforce the Achilles after the diseased portion has been removed. Following this operation the ankle is in plaster for 6 weeks and a removable boot for a further 6 weeks. Physiotherapy progress is slower than with the Leeds-Kieo tape treatment.
