Achilles Non-Insertional Tendonitis

• Pain and stiffness along the Achilles tendon in the morning
• Pain along the tendon or back of the heel that worsens with activity
• Severe pain the day after exercising
• Thickening of the tendon
• Swelling that is present all the time and gets worse throughout the day or with activity
• Pain on the back of the heal when you wear shoes

• Weight-bearing X-rays are required
• MRI scan may be required

A walking CAM (controlled ankle motion) boot or moon boot may help reduce the inflammation. Occasionally a PRP (platelet rich plasma) injection may be offered. This can help promote reduction in inflammation and healing of the tendon. Application of glyceryl trinitrate patch has been shown to be effective.

Surgery is considered if non-operative treatment is unsuccessful after more than 6 months.

It may consist of:

• Arthroscopic debridement
• Open debridement of the unhealthy tendon and augmentation of the main Achilles tendon

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.