The chronic condition of Achilles tendinosis is referred to as degenerative tendinopathy. This foot and ankle condition is associated with the gradual degeneration of the Achilles tendon. There are times when the Achilles tendon does not function correctly because of:
• Multiple, minor microscopic tears of the tendon
• Limited ability of the tendon to heal and repair itself
The blood circulation to the Achilles tendon in some patients is not always as good as it should be. This lack of blood circulation causes microscopic tears inside the tendon. The ability to heal these microscopic tears is limited and tearing of the tendon continues. Eventually, the tendon begins to thicken and weaken and becomes quite painful.
Degenerative tendinopathy usually occurs in patients who are:
• Between 35 and 45 years old
• Not necessarily athletic
Degenerative tendinopathy symptoms include:
• Tendon and leg pain
• Pain and weakness when pushing off the leg
• Swollen and visibly thickened Achilles tendon
Degenerative tendinopathy is diagnosed with a physical exam. The Achilles tendon can be felt with the finger as an elongation that is thickened in the tendon.
Treatment for degenerative tendinopathy begins with:
• A very carefully designed program of stretching
• Specific type of physical therapy
• Either a boot or brace designed for treatment of chronic tears of the Achilles tendon
If pain and weakness continue after prolonged boot treatment, then surgery is necessary to repair and reconstruct the degenerated Achilles tendon. Full and successful treatment is unfortunately not always successful without surgery.
Surgery is not always predictable, since the tendon has deteriorated, and it may not be possible to get it to heal again. The deteriorated portion of the tendon is removed and the healthy sides of the tendon are stitched together. If the extent of the degeneration is severe, a tendon transfer is performed. The tendon transfer is done much like the repair for chronic Achilles rupture.