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If left untreated, chronic stress and strain placed on the Achilles can lead to Achilles Tendinosis. This condition is marked by microscopic tears to the Achilles tendon and possibly the surrounding tissue, which in turn develop into stiff scar tissue. The Achilles tendon then becomes enlarged and painful. If left untreated, this condition can result in chronic Achilles pain and loss of function making even day-to-day tasks difficult.
Achilles tendinosis is commonly the long term complication of achilles tendonitis which is not treated in a timely and acceptable fashion. Tendonitis means inflammation of a tendon which tendinosis means scar tissue of a tendon. In tendinosis cases, the tendon is under chronic strain and has had previous microscopic injury to the area. Over time, the chronic microscopic damage causes scar tissue to form and the body begins to 'give up" caring for the region due to the long term period of injury. The goal of tendinosis cases is to increase blood supply to the damaged tendon region and increase the bodies healing process of the tissue again. With protection, the body will begin the heal the damaged tissue.
We usually begin tendinosis cases with physical therapy services to increase blood supply and break scar tissue with in the tendon. Protection with bracing or a boot may also be necessary. However, these treatments are less effective for treating Achilles tendinosis than treatments such as Platelet Rich Plasma (PRP) Therapy or Minimally invasive Achilles surgery with Tenex treatment.
Platelet Rich Plasma (PRP) Therapy for Achilles Tendinosis Platelet rich plasma therapy can be used to treat Achilles tendinosis. The procedure is the same as that used to treat tendonitis. The injected plasma causes the body to begin healing the affected area, removing scar tissue in the case of Achilles tendinosis.
Long view ultrasound image of an Achilles tendinosis. Scar tissue noted in black region.
The Tenex treatment is one surgical option for removing the damaged tissue that results from Achilles tendinosis. Scar tissue and damaged parts of the tendon are removed using a specialized tool called a Tenex probe. This tool breaks up the scar tissue and facilitates blood flow to the area, accelerating the healing process. The Tenex procedure has allowed for a minimally invasive controlled tissue repair and scar tissue removal of the tendon damaged region. A needle sized opening is made and a specialized probe is introduced under ultrasound guidance which allows a guided break up of the scar tissue and increased tissue healing and blood supply to the damaged tissue.
In some rare cases, the Achilles tendon has so much damage to it that it is barely usable and severely damaged. In such cases, not only is the tendon painful but it is often not even functioning at all. If severe damage is noted, an open surgical repair of the tendon is planned. A tendon augmentation surgery is used which allows a second tendon to be attached to the main Achilles tendon to help with strength and function. Recovery after this procedure will involve the use of crutches while the tendon heals.
In cases of chronic, continued scar tissue formation, the Topaz coblation may be needed to break up the scar tissue and bring new blood to the area. This procedure turns a chronic condition into an acute condition that can heal in a controlled setting. In most cases, the patient is placed in cast and crutches may be used for mobility while the tendon heals.
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| Image of Achilles split open to repair the thickening scar tissue | Image of the Topaz probe being used to fenestrate the Achilles. |
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| Image showing the pinpoint holes | Image showing repaired Achilles tendon |
