Chronic localised pain in the Achilles tendon may lead to, or result from, a rupture of the tendon. Pain and restricted activity may arise from damage either to the main body of the tendon or where it inserts into the heel bone. The first may be due to either Achilles tendonitis (an inflammation of the superficial covering of the tendon) or Achilles tendinosis (degeneration of the substance of the tendon). Insertional pain can originate from a healthy tendon being compressed by a prominent heel bone, known as a Hagglunds deformity. Alternatively the inserting tendon may have undergone degenerative changes as well (tendinosis). Degeneration can occur if the tendon’s natural capacity for repair is repeatedly exceeded.
Non-operative management will often be a first stage, with physiotherapy, orthotics or cast immobilisation to relieve weight and stress to the tendon for several weeks. Should this fail to help, imaging the tendon with MRI or Ultrasound scan will identify operative options. If degenerative tendinosis is identified, operative intervention may be either minor or major debridement, depending upon severity of degeneration. If diagnosis shows healthy tendon substance, steroid injection around the tendon may reduce inflammation of the tissue.
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