The Achilles tendon is the largest tendon in the human body and can withstand forces of 1,000 pounds or more. But it is also the most frequently ruptured tendon, and both professional and weekend athletes can suffer from Achilles tendonitis, a common overuse injury and inflammation of the tendon.
Recurrent stresses on the tendon where it attaches (the insertion) or slightly higher up the leg (non-insertion) lead to degeneration, inflammation, microscopic tearing of the tendon, swelling and pain.
There also may be associated swelling in the space between the tendon and the calcaneus, called the retrocalcaneal bursa. The back of the heel may be enlarged and thickened. The thickening may result from bone spurs on the back of the calcaneus which develop within the substance of the tendon.
A comprehensive treatment plan is implemented for this problem. All of these are designed to decrease the inflammation on the tendon that occurs with normal activity. In cases where non-operative treatment has failed, surgery may be indicated, which may include the removal of excess bone, repair of the Achilles tendon itself, removal of bursitis, and possible augmentation of the repair with a transferred tendon. Depending on the extent of tendon involvement, a minimally invasive approach or the traditional open incision may be used.
Dr. Carreira has prepared a document that offers some insight into the treatment of Achilles tendon injuries:
Download Treatment of Achilles Tendon Injuries » (PDF: 347KB)
Presenting to the American Orthopedic Foot and Ankle Surgeons
In July 2018, Dr. Dominic Carreira presented the Achilles insertional reconstruction technique to approximately 50 orthopedic foot and ankle surgeons at the recent annual meeting of the American Orthopedic Foot and Ankle Society (AOFAS) in Boston. This layered technique of reconstruction is reliable and reproducible and has minimal potential complications.
As an orthopedic surgeon, Dr. Carreira regularly presents at educational seminars and annual meetings of medical and surgical societies. Additionally, he actively contributes to medical research, and publishes articles in leading medical journal, adding to the body of medical knowledge. Dr. Carreira’s full CV is available for review.
Achilles and Retrocalcaneal Bursa Surgery: General Facts of Recovery for Open Surgery
- The surgery is performed as an outpatient procedure
- A 2-5 cm incision is made on the back of the heel
- Following surgery, you will need to use crutches for two weeks
- At the first office visit, you will be able to start walking in a removable walking boot.
- The boot is worn for 4 6 weeks, and then the weaning process into a shoe is begun.
- The shoe should have an open back to prevent rubbing on the heel and tendon.
- Physical therapy is an important part of your recovery, starting at 6 weeks.
- You can expect swelling and tenderness at the back of the heel for about 4 6 months after surgery.
Post Operative Course:
- Foot wrapped in bulky bandage
- Ice and elevate the foot
- Take pain medication
- Expect numbness in foot for 12- 24 hours
- Bloody drainage through bandage expected
- Do not change the bandages
- First follow up in the office
- X rays taken
- Dressing changed, sutures may be removed
- Special boot is applied to the foot
- Weight bearing in the boot as tolerated
- The boot is removed
- Stretching exercises are begun
- Physical therapy is important
- Wear an open heel shoe for approximately one month
- Strengthening exercises may be initiated
- Gradual return to full activity including sports
Photos of Achilles Pain