Member Case Study: Chronic Tendonitis, Tendonosis

author : AMSSM

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I have had chronic Achilles tendonitis problems for a good portion of my life. I am wondering if this can ever go away, or if there is a surgery that can be done?

Question from Tracymathes
I have had chronic Achilles tendonitis problems for a good portion of my life, and I am 41. I have tried everything there is to help remedy the issue (orthotics, massage, laser, ultrasound, ice, heat, meds, every type of running shoe, PT, rest) and I am wondering if this can ever go away, or if there is a surgery that can be done. I have been told they don't seem as though they are ruptured and they don't look overly inflamed or red. I do have tight calves which affects the Achilles and even the shins, but I do stretch. Help!

Answer by Dr Roger McCoy 

Member AMSSM

Chronic tendonitis is a frustrating problem for doctors and athletes, but there are options for treatment. Initially, when the tendon is first injured and inflamed, ice, anti-inflammatories, and activity modification is best. When the tendon condition persists beyond four to six weeks, doctors often call it “tendonosis.” This is because at this stage, there is actually less inflammation in the tendon, but the inflammation has led to cellular damage of the collagen fibers that compose the tendon. This is basically scar tissue deposition in the tendon, resulting more in a painful, dysfunctional tendon than an inflamed tendon. Once the tendon injury has become chronic, typical anti-inflammatory measures (like ibuprofen, ice, and cortisone) aren’t very effective.

Other treatments, like orthotics and physical therapy have variable success. Orthotics are best made by podiatrists, pedorthotists, or physical therapists who have taken advanced course work and have had several years of experience in making orthotics. Surgical techniques are usually reserved for tendon tears.

One current thought is that the best way to heal chronic tendonosis may actually be to re-damage the tendon in a controlled way. Some doctors recommend physical therapy techniques like ASTYM (Augmented Soft Tissue Manipulation). The ASTYM web page can help you find a therapist in your area with this training. Doctors at several institutions, like Arizona State University, have had good success with this technique.

In addition, it is critical that you address your tight calves and any other biomechanical issues in your foot dynamics (such as a high arch or abnormal gait pattern).

Dr Roger McCoy 

Arizona State University
 

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date: December 11, 2007