Understanding Achilles Injuries and Modern Treatment Options

Achilles injuries are common in active individuals and can significantly impact daily life and mobility. Two main conditions often discussed are Achilles tendinopathy and Achilles tendon rupture, each requiring specific approaches to treatment. Mr Pavel Akimau, a consultant orthopaedic surgeon with expertise in foot and ankle conditions, provides insight into how these conditions can be managed, offering both conservative and surgical options tailored to the patient’s needs. 

What is Achilles Tendinopathy?

The Achilles tendon is the largest and one of the most powerful tendons in the human body, connecting the calf muscles to the heel bone. Achilles tendinopathy is a condition characterized by pain, swelling, and impaired function of the tendon due to overuse or degeneration. It can affect the middle portion of the tendon or the lower insertion area where the tendon meets the heel bone. 

Symptoms often include stiffness and pain along the back of the heel, especially during activity. Runners, athletes, and people who suddenly increase their physical activity are particularly prone to this condition. 

Achilles Tendinopathy Treatment

Treatment for Achilles tendinopathy usually begins with conservative, non-surgical measures. These approaches aim to reduce pain, promote healing, and restore strength and flexibility to the injured tendon. According to clinical research and expert recommendations, conservative options often include:

• Rest and Activity Modification: Reducing activities that exacerbate pain is critical in the early stages of treatment. 

• Physical Therapy: A structured physical therapy program helps rebuild strength and improve tendon function. Eccentric exercises, which involve lengthening the tendon under load, are especially effective for many patients. 

• Orthotic Support: Devices such as heel lifts or cushioned shoe inserts can reduce strain on the Achilles tendon. 

• Extracorporeal Shockwave Therapy (ESWT): This non-invasive therapy uses sound waves to stimulate healing in damaged tendon tissue and can be beneficial for chronic cases. 

These treatments are typically tried for several weeks to months, depending on symptom severity. Many patients experience significant improvement without the need for surgery.

Insertional Achilles Tendinopathy Treatment

Insertional Achilles tendinopathy refers specifically to problems at the point where the tendon attaches to the heel bone. This area can be more challenging to treat because movements that stretch the tendon can aggravate symptoms. 

For insertional Achilles tendinopathy, the initial focus remains on conservative care, but with modifications. For example:

• Activity Modification: Avoiding exercises that excessively dorsiflex the ankle (bend the foot upward) is often recommended.

• Physical Therapy with Modified Techniques: Therapists may adapt strengthening exercises to minimize stress on the insertion site while still promoting healing. 

• Shockwave and Other Therapies: ESWT can still be considered, and in some cases, advanced imaging helps guide treatment. 

When conservative measures fail, surgical intervention may be recommended. Mr Pavel Akimau highlights minimally invasive surgical options for insertional tendinopathy that can relieve pressure, remove degenerative tissue, and improve tendon function with quicker recovery compared to traditional open techniques. 

Achilles Tendon Rupture Treatment

An Achilles tendon rupture is a more severe injury where the tendon partially or completely tears, often occurring during sudden, forceful activities. Patients may hear a “pop” and experience immediate weakness and difficulty walking or standing on tiptoe. 

Treatment for an Achilles tendon rupture depends on several factors, including age, activity level, and rupture severity. Options include:

Nonsurgical Treatment

This approach may involve:

• Using a walking boot or cast to keep the foot in a pointed position, reducing tension on the tendon.

• Gradually transitioning to weight-bearing and rehabilitation exercises under professional supervision.
  Nonsurgical care avoids surgical risks but may carry a slightly higher risk of re-rupture for some patients. 

Surgical Repair

Surgery involves stitching the torn tendon back together, often reinforced with healthy tissue. Minimally invasive techniques have become more common, offering lower infection risk and faster recovery compared to traditional open surgery.

Regardless of the chosen route, rehabilitation is essential. Physical therapy focuses on restoring strength, flexibility, and function, helping most individuals return to their previous activity levels within several months. 

Conclusion: Modern Care for Achilles Conditions

Achilles injuries range from tendinopathy caused by overuse to full tendon ruptures from acute trauma. Treatment strategies vary but often begin with conservative, non-surgical options centered on physical therapy, activity modification, and supportive care. For stubborn or severe cases, including complex insertional tendinopathy or complete ruptures, surgical intervention—especially minimally invasive techniques like those offered by Mr Pavel Akimau—can improve outcomes and help patients return to active lives. 

Whether you’re dealing with chronic heel pain or a sudden tendon tear, understanding your options and working with knowledgeable professionals is key to achieving optimal recovery. With the right care, most people can overcome these challenges and regain full mobility.