Every one has had pain in a tendon at one time or another, either spontaneously or from an injury. Occasionally this pain becomes chronic and severe, and we will discuss this today with an emphasis on the achilles tendon. The achilles tendon connects the gastrocnemius muscle of the calf to the heel bone, and we have discussed ruputres before. Often the tendon becomes swollen and tender over the subcutaneous area just above the heel and every step hurts.
Initial treatment includes ice , non steroidal anti-inflammatory medications and stretching. This treatment plan often works and the pain resolves. In some cases, pain and swelling pesist and there is a fusiform swelling over the tendon. This chronic treatement resistant condition is called tendonosis.
Tendonosis is pathologically characterized by neovasculariztion (new blood vessels) and a poor healing response and this is thought to be the source of the pain. This phenomenon can be seen in other tendons as well. The treatment options are multiple but the best option is not known. Cortisone injections rarely work and particularly in the achilles tendon may lead to rupture. High and low energy shock waves have been tried (they are thought to change the healing response) and the results are poor for low energy and mixed for high energy shock waves. Nitrous oxide patches may work, but here is no evidence that plyotherapy (saline injections ) work. Surgery with either major stripping of the tendon lining, or percutaneous longitudinal incisions has also been used with mixed results
Ths best advice is to work through the exercise and ice and massage regime and gradually use other modalities. In any case there is no quick, 100% reliable treatment and one can expect at least a six month course.
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