Achilles tendon disorders are quite common among athletes and other individuals who perform physical activities that require a lot of movement. The symptoms that most often affect this tendon are pain and stiffness. However, more serious problems may sometimes arise, such as a complete rupture of the tendon. Though many Achilles tendon disorders do not require surgical treatment, sometimes surgery is indeed necessary.

The aforementioned pain and stiffness may be due to tendinosis, a degeneration of the Achilles tendon caused by overstrain. This condition makes the patient’s Achilles tendon feel sore and stiff in the morning, and the symptoms usually worsen during exertion. It often causes a fusiform thickening of the tendon as well (Fig 1). If the symptoms persist despite other treatments, the condition can be treated via surgery.

Chronic peritendinitis, an irritation of the tissue surrounding the Achilles tendon caused by excessive strain (for example, intense and/or long-distance running), may also require surgical treatment. During this particular surgery, the peritendinous adhesions (a sort of scar tissue) that formed around the Achilles tendon are removed. The patient is often able to run again approximately 3 months after the surgery.

Haglund's deformity (also known as Haglund’s heel) is a condition that typically affects endurance runners, in which a bony protuberance or “bump” forms on the back of the heel bone irritating the soft tissue and the Achilles tendon (Fig 2-3). This often causes bursitis, a painful inflammation. During the surgical treatment for this condition, the bony protuberance is removed from the heel bone so that it no longer pinches or rubs against the tendon and surrounding soft tissue. The patient is able to walk normally 4 weeks after the surgery, and is able to run at a mild pace approximately after 3-4 months.

The Achilles tendon sometimes tears completely unexpectedly. This can happen, for example, when it is subjected to a sudden strain or change of direction. The tendon can tear either partially or completely. When a complete tear occurs, a strong “pop” is often felt in the lower part of the calf, which is sometimes loud enough to be audible. In most cases, the diagnosis can only be made via examination. Treatment options are either orthosis or surgery. The final decision regarding treatment should be made in conjunction with an orthopedic surgeon familiar with the condition. The best treatment option for athletes is usually surgery. During the surgery, the two ends of the torn tendon are sewn back together. Soon after the surgery, a gradual recovery process begins. It takes approximately 2 months for the patient to be able to walk normally, and approximately 4 months for him or her to be able to run at a mild pace.

Lasse Lempainen
Orthopaedic surgeon