The Achilles tendon is a strong cord that connects the calf muscle to the heel. It enables you to point your foot down and raise your heel, and propels you forwards as you walk or run.

Small tears can develop in the tendon fibres through overuse (running, for example). The blood supply is not very good to the tendon, and it doesn’t repair easily. As a result, the tendon and its lining then become painful and swollen. The degeneration of the tendon is called tendonosis and the inflammation of the lining is tenosynovitis.
Sometimes the tendon tears completely. Ruptures of the Achilles tendon often occur in weakened tendons, and happen when the tendon is overstretched. They often occur in middle aged men while playing sports such as squash.

With a ruptured tendon, you will feel a pop or a snap, then a sharp pain in the back of the ankle. You may feel as if you have been kicked, or even shot, and you will find it extremely difficult to walk. With a partial tear, you may still be able to move your foot and only experience slight swelling. With tendonosis, you will feel pain in one area of the tendon, which may occur during or after activity. If the problem progresses, you may feel pain when you’re at rest or even at night. You may only feel pain when wearing shoes, indicating that the problem is to do with the tendon’s attachment to the heel bone.

An ultrasound scan will can show tendon injury or degeneration. An MRI scan can also be used. An X-ray of your heel can show if there are other problems with the heel bone.

Debridement and Tendon Construction

If there is minor degeneration, areas of tendon can be stimulated to repair themselves. Small cuts are made to the tendon during arthroscopic surgery, which stimulates an in-growth of blood vessels and results in a healing response.

Tendon Reconstruction

If the tendon has ruptured completely, a cut is made in the back of the heel and the two ends of the tendon are sewn together.

In the case of severe tendonosis, the deteriorated areas of tendon are removed, and other tissues (another part of the Achilles tendon, or a tendon from the big toe) are used to replace them. The new tissue is attached to the cut section of the Achilles tendon, and stitches are used to hold it in place.

You will wear a cast for up to six weeks after surgery, when you will transfer to a lightweight air cast walking boot. It may be twelve weeks before you are able to put full weight on the foot. Sports can be resumed after six months, but it may be twelve months before full strength is restored.