Achilles Tendinopathy injuries: types & treatment

The surgical management depends on the type of condition. Tendinopathy is the symptomatic form of an upstream problem. Surgery will be offered when a conservative treatment fails, usually after 4-6 months.

Regarding the treatment of insertional tendinopathies, the necessary information is available on this page.

For ordinary non-insertional tendinopathy, without severe tendon damage and gastrocnemius equinus, a “cleaning of the tendon” is regularly offered. It consists of addressing the tendon directly, excising the affected or extremely inflamed areas (synovectomy) and stimulating healing through micro-incisions in the tendon (combing).

A gastrocnemius equinus is often observed in patients suffering from Achilles non-insertional tendinopathy. This shortening of the gastrocnemius tendon, at the start of the Achilles tendon, may be performed surgically. The preferred procedure consists of a partial or sometimes full section of the gastrocnemius tendon (Strayer procedure). This will significantly reduce the traction exerted on the Achilles tendon. The gastrocnemius will then relax and re-attach itself to the soleus muscle to recover its function but now with an appropriate limitation.

 

Lengthening of gastrocnemius according to Strayer

 

This technique is typically performed through a 3-cm incision on the inner edge of the calf, at the gastrocnemius-soleus junction. This technique can now be performed endoscopically. It allows a 3-mm incision and, therefore, carries a lower risk of complications. It is currently our preferred option.

Finally, in the most severe cases or when ruptures to the Achilles tendon have been incorrectly treated, it is sometimes necessary to excise the entire area affected. This surgery, which can be major, is reserved for the most severe cases. Depending on the extent of tendon removed, either a direct reconstruction or transfer to another tendon of the leg is required to replace the function of the Achilles tendon.

Besides the possible complications after any type of surgery (thrombosis, infection, algodystrophy), the risks associated with Achilles tendon surgery are as follows:

• The sural nerve, whose pathway passes close to the surgical area, can sometimes be affected. It is primarily a sensory nerve whose injury is generally regressive.
• The skin, in this region, is fragile and subject to considerable stresses. Healing problems have been reported when the patient returns to work too early or when there is bruising.
• Ruptures of the Achilles tendon or muscles have been described (very rare)
• When a total reconstruction of the Achilles tendon is required, it is often necessary to remove a tendon in the vicinity, typically the tendon responsible for flexing the big toe (long flexor of the hallux). If this occurs, a flexion weakness is sometimes observed in the toe.