Tendinitis, tendinosis, same thing, right? The answer is a resounding no! These are two completely different problems with your Achilles, and understanding the difference is the only way to treat them properly.
Unlocking the Truth
Achilles tendonitis is an overuse injury most often seen with athletes and highly active people. It is a painful inflammation of the tendon as a result of repetitive stress or trauma. If the pain is chronic, however, the condition becomes degenerative with possible tearing and a thickening buildup of scar tissue. It has now crossed over into the Achilles tendinosis zone.
Your pain has just traveled into another dimension—a dimension beyond that which is known to the common man. What lurks in the shadows of your imagination can be cleared by the knowledge of Dr. Craig H. Thomajan DPM, FACFAS and Dr. Shine John, DPM, FACFAS.
Zoning In on the Problem
With Achilles tendinosis, persistent pain can be felt at the back of the ankle along the tendon that connects your heel to your calf. Pain may be isolated to the heel bone or extend up into the calf muscle. The symptoms are similar to tendinitis, but if the inflammation and pain does not go away with treatment, the tendon can accrue a thick layer of scar tissue, also called fibrosis. This can permanently thicken the tendon and cause chronic tightness, along with pain. There may be a protruding, bulbous region visible around the affected area.
Causes of tendinitis are also indirectly responsible for tendinosis. Inflammation that later leads to degeneration can occur for a number of reasons. If runners increase their mileage or run on hard surfaces like cement, for instance, they are risking injury to their Achilles. Biomechanical imbalances or structural issues like flat feet put too much stress on the tendon and lead to the condition as well. Tight calf muscles along with poor flexibility can also be culprits. Another is an imbalance of muscle strength between your calf and shin.
Treatments That Push Boundaries
If treated early, Achilles pain can be stopped before tendinosis sets in. Stretching and icing several times a day is recommended. We may suggest that you take an anti-inflammatory medication, too, and avoid weight-bearing exercise. Orthotics may also be prescribed.
If you do enter into the tendinosis stage, a unique aspect of physical therapy called ASTYM can help. ASTYM is a manual pressure technique that re-stimulates inflammatory mechanisms and healing responses in your body. This combined with strengthening and stretching exercises can resolve the tightening and thickening of the tendon associated with Achilles tendinosis. PRP treatment, EPAT and MLS laser therapy have also been used effectively in the treatment of tendinosis.
Another procedure actually involves inflicting microscopic trauma to the region in order to increase circulation and healing. This can be done surgically or with what’s called a microtenotomy technique which uses a probe and radiofrequency. Severe cases may need a more aggressive surgical approach.
If your Achilles pain has just traveled into another dimension—one that is beyond the realm of tolerance, it’s time you entered in to the expert zone. Call Dr. Craig H. Thomajan DPM, FACFAS and Dr. Shine John, DPM, FACFAS at (512) 328-8900, or visit us at Austin Foot and Ankle Specialists here in Austin, TX, today!
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