Achilles Tendinopathy
This page describes the condition of Achilles Tendinopathy and the approach to this condition adopted by Mr Bowyer at Spire Southampton. Other surgeons may use variations on the techniques, for instance with regard to post-operative management. It is important that you understand what your own surgeon intends to do, and how you will be treated after the procedure.
Achilles tendon pain may come on gradually, or rapidly following an increase or change in sporting activity (or change of footwear); sometimes it just happens! The Achilles tendon behind the heel (the “heel cord”) is typically swollen, painful and tender, and function is inhibited as the tendon hurts, especially at push off.
Initial Treatment
Early treatment can often lead to resolution of the condition in 6-8 weeks. Treatment will consist of rest (possibly with a support boot), ice, compression and elevation. Non-steroidal anti-inflammatories may be useful, as tablets or an applied gel.
Early physiotherapy is appropriate. Once the condition is settling, then stretching exercises, followed by strengthening regime, will often be used and a removable in-shoe heel raise might be helpful. Assessment by a podiatrist might also be helpful, particularly in patients with flat feet.
The use of steroid injections is controversial, and most doctors will be wary of this because of potential complications.
Cases that do not settle
There are some conditions in the foot and ankle, Achilles tendonitis and plantar fasciitis in particular, which are difficult conditions to treat, and the symptoms and disability often seem to persist despite appropriate early treatment – they are problems for the patient and the orthopaedic surgeon alike!
A relatively new treatment, Extracorporeal Shockwave Therapy (ESWT) or lithotripsy, has been successful in many cases. The National Institute for Health and Clinical Excellence (“NICE”, sometimes called the health watchdog) has looked at the procedure in detail, and approved its usage in certain circumstances.
The treatment is carried out in the outpatient department which has the special equipment, there is no need for anaesthetic, and each treatment session lasts 5-10 minutes.
ESWT is non-invasive – no cuts are made and no needles are used. A gel is applied to the skin over the painful area, and the impulse device is pressed against the area and small shock waves are generated. A treatment session lasts about 5 – 10 minutes.
for more information on ESWT Click here
