Tendon Problems – Treatment and Surgery

What are tendon problems?

The tendon is a band of tissue that connects a muscle to a bone. The Achilles tendon is the longest tendon in the body, which runs down the back of the lower leg and connects the calf muscle to the heel bone. The Achilles tendon facilitates walking by helping to raise the heel off
the ground.

Two common disorders that occur in the heel are Achilles tendonitis and Achilles tendonosis.

Achilles tendonitis is an inflammation of the thin membranous tissue
that covers the Achilles tendon (paratenon). This inflammation is short in duration. Over time, however, the condition may progress to a degeneration of the tendon called Achilles tendonosis.

In these instances, the tendon loses its organized structure and may tear. Sometimes the degeneration involves the site where the Achilles tendon attaches to the heel bone. Chronic degeneration with or without pain may even result in rupture of the tendon.

Symptoms associated with Achilles tendonitis and tendonosis include pain, aching, stiffness, soreness, and/or tenderness within the tendon. This may occur anywhere along the tendon’s path, from the narrow area above the heel to below the calf muscle.

Often pain appears in the morning or after rest, and then improves with motion, only to worsen with increased activity. Eventually, the tendon may become enlarged and develop nodules in the area where the tissue is damaged.

What causes tendon problems?

A sudden increase in an activity involving the Achilles tendon is a typical cause, as activity puts too much stress on the tendon too quickly, thus resulting in injury to tendon fibers. Ongoing stress on
the tendon makes the body unable to repair the injured tissue. The structure of the tendon is then altered, resulting in continued pain.

Individuals with flat feet and athletes are at high risk for Achilles tendon problems. Achilles tendonitis and tendonosis are also common in individuals whose work puts stress on their ankles and feet, and individuals who exercise sporadically at increased intensities (“weekend warriors”).

What is the treatment?

What is the treatment? Surgical and non-surgical treatment depends on how long the injury has been present and the degree of damage to the tendon.

To prevent Achilles tendonitis or tendonosis from recurring, a foot surgeon may recommend strengthening and stretching of the calf muscles and orthotics to reduce tension on the tendon. Properly-fitted shoes for the foot type and activity is also important.