The achilles tendon How soon should they work?
Some improvements soon, perhaps within days or weeks. Lasting improvement however takes longer, possibly up to 6 months. If symptoms have failed to shift much by this stage they are unlikely to with further conservative treatment. What is the chance of success of non-operative management?
All told expect somewhere in the region of 50-75% success rate. What can be done if non-operative treatment fails?
Define the exact nature of the problem by imaging the tendon. The options are either MRI scan or Ultrasound. If ultrasound is used and if this reveals the tendon substance to be healthy (ie not a tendinosis) but suffering a tendonitis (inflammation of the surrounding 'sheath'), then at the same sitting the inflamed tissue around the tendon can be injected (with local anaesthetic and steroid).
This should be followed by a period of reduced activity. Why not inject around a tendon with tendinosis?
Steroid placed around a degenerate tendon runs a risk of acute rupture of the tendon. What if the tendon is degenerate? (Tendinosis)
The scan will have defined the extent and given a good idea of the severity of the tendon degeneration. There are two main types of operative intervention, either a minor debridement or major debridement with removal of large portions of tendon and tendon reconstruction (possibly with a tendon transfer). What is the rationale behind the operations?
In cases with more minor degrees of degeneration such areas of tendon can be stimulated to repair themselves by incising the tendon, which stimulates an in-growth of blood vessels and results in a healing response (Link to tendon debridement operation gallery). With severe degeneration, once all unhealthy and painful tendons are excised a large defect needs to be closed to allow the tendon to function mechanically again. Various tissues can be used .One of the most common and successful is to transfer the tendon and muscle belly of the big toe flexor, which sits adjacent to the Achilles. (Link to FHL Transfer gallery)
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