Achilles Tendon pain is a relatively common complaint in your podiatrist’s office. After a complete examination and confirmation that it is indeed the tendon itself, it should be determined how long the pain has been bothersome. What extends beyond even the Achilles tendon, is the chronic vs acute nature of a tendon injury…the time that the pain has been present is a determining factor on the basis of our treatment plan and this distinction must be made for better outcomes.
Tendinitis is an acute injury to a tendon. Physiologically, tendinitis is an inflamed tendon, and when looked at under a microscope should not show damage to the tendon itself. Tendinosis is a chronically damaged tendon where torn fibers, calcifications, and scar tissue are present. In these cases, the tendon has been injured and inflamed for an extended period of time and has caused thickening, scarring, damaged, and degeneration to the tendon fibers.
Treatment varies depending on the type of tendinous pain. Tendinitis may be treated with rest or immobilization, ice, compression, elevation, physical therapy, and anti-inflammatories. These treatment modalities usually begin to show signs of improvement within a couple weeks.
For the long-standing injuries, or tendinosis, there may be no signs of active inflammation at all. Tendinosis is the result of breakdown of the components of the tendon itself. This degeneration of the tendon likely comes from long term overuse without allowing the tendon to heal. Some of the treatments are amongst the two, including immobilization or rest of the affected tendon, and physical therapy. The difference is that the physical therapy programs will likely play a much larger role and provide more massage, eccentric strengthening, light stretching, cold therapies, as well as many other modalities. Additional therapies can include bracing/taping, icing, nutritional changes, extracorporeal shock wave therapy (ESWT), and platelet rich plasma (PRP) injections. With appropriate treatment at this stage, tendinosis can begin to resolve at four to six weeks but, may take as long as four to six months before relief is adequately improved.
The cellular damage that has already occurred in patients with tendinosis will likely not be reversed, however, by breaking the cycle of injury and allowing the tendon to heal in a more appropriate manner may permit the discomfort to resolve in many cases. In those that do not resolve, more invasive approaches to treatment can be discussed with your podiatrist.
Achilles tendon injuries are fairly common, and although the majority resolve with the initial treatments, failure to improve can be an indication that something else may be happening at the microscopic level of the tendon. Many patients do not understand that the treatment of a tendon injury is partially based on the time it takes for the patient to seek care and to obtain an accurate diagnosis. This is the first step to get you feeling better and could potentially make the treatment more tolerable and recovery time shorter.
Dr. Bartholomew is a member of the ACFAS. He is board ABPM certified and ABFAS qualified in forefoot and rearfoot reconstructive surgery. He earned his podiatric medical degree from Temple University School of Podiatric Medicine in Philadelphia, PA and Geisinger Community Medical Center Residency in Scranton, PA. He currently practices with Family Foot and Leg Center in Cape Coral and Fort Myers. Dr. Bartholomew can be contacted at (239) 430-3668 (FOOT).
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Contact:
Patrick Bartholomew, DPM
(239) 430-3668 (FOOT)
Lee County, Florida
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Serving Southwest Florida Since 2005, Family Foot & Leg Center has 9 convenient locations throughout Collier, Lee, Charlotte, and Sarasota Counties. Offering pediatric to geriatric family care: Ingrown Toenails, Heel Pain, Bunions, Foot / Ankle Arthritis Pain, Plantar Fasciitis, Foot / Ankle Surgery, Custom Orthotics, and Diabetic Wound Care. In office X-rays, ultrasounds, and minor surgical suite exam rooms. Practice powered by EMR and advanced technologies. Home of the Lam Minimal Invasive No-Scar Bunion Surgery! Come Discover Why Patients Love Our 5-Star Foot & Ankle Care! Same Day Appointments! Easy Online Appointment Scheduling!
