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Monday, May 24, 2021

Achilles Injuries when more than "Itis": Partial Tears and Tendinosis (Dr. Blake's Office Handout)

The following is my office handout for patients who present with more than inflammation to the achilles called achilles tendonitis. The tendon typically is swollen compared to the other side, and the pain is more than in "itis" situations. Tendinosis is typically chronic, where partial tears can be acute or chronic. 

Achilles Tendinosis and Partial Tears 

     Achilles Tendinosis implies that the tendon is damaged more than inflamed (like in Achilles Tendinitis conditions). Partial Tears are part of this condition that drives everyone, doctor and patient, bananas. There are so many degrees of tendon disease. MRIs, if possible, should always be done to document what is going on. The top 10 treatments for achilles tendinosis and partial tears are:

1.      When the tendon is thicker than normal, or swelling that will not go away, consider an MRI to check if a partial tear is present.

2.      With tendinosis, some form of immobilization is important to create a pain free  environment (tape, below knee cam walker, AFO, high top boot).

3.      With a partial tear of the achilles tendon, 3 months of cam walker/removable boot is crucial (when a pain free situation cannot be obtained with activity modification).

4.       With tendinosis, physical therapy can occur at the same time as the immobilization, but with a partial tear, physical therapy normally starts after the 3 months of immobilization.

5.        Both of these conditions may require surgery, so a surgical consult should be done to evaluate options (so that the patient is aware of their upcoming choices).   

6.       As the tendon gets less sore with icing for 5-10 minutes 3 times per day, gradually begin to strengthen. I love 2 positional heel raises up to 100 each evening as long as there is no pain, gradually leaning to the injured side, and gradually progressing to 25 one sided calf raises.


7.      Achilles tendon stretching, both straight and bent knee, should be done painlessly 3-5 times a day.

8.        PRP injections is a rising star in medicine, in an attempt to hopefully avoid surgery, may be considered.

9.       Like in all cases of achilles pain, heel lifts and custom orthotic devices are standard.

10.    Avoid barefoot and negative heel positions for a year following the Return to Activity Phase.

When the heel drops below the plane of the ball of the foot, it is considered in a negative heel position, and can get over stretched and re-torn.

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.