Chronic Achilles Tendinosis Treatment in Los Angeles

What Is Chronic Achilles Tendinosis?

Achilles tendinosis is a chronic condition that develops when untreated Achilles tendonitis worsens over time. The Achilles tendon, a strong and thick band of tissue connecting the calf muscle to the heel bone, plays a crucial role in foot movement and propulsion. Normally, it functions like a rubber band, stretching and contracting with each step. When the tendon is acutely injured and inflamed, it is called Achilles tendonitis. However, if left untreated or if conservative treatments fail, the condition can progress into Achilles tendinosis, where the tendon thickens, swells, and becomes visibly damaged. Over time, this can lead to partial tears and, in severe cases, a full Achilles tendon rupture.

Dr. Soomekh, the leading Achilles tendinosis doctor in Los Angeles, will provide a comprehensive treatment plan to get you pain-free and back to normal.

Signs and Symptoms of Chronic Achilles Tendinosis

Achilles tendinosis causes persistent pain and noticeable thickening of the tendon. Patients often experience a deep, achy pain that can sometimes feel sharp and knife-like. The pain is most pronounced with each step during walking or activity and may even be present at rest.

• A visible mass of swelling and thickening in the tendon
• Significant pain when applying pressure or squeezing the swollen area
• Substantial pain when taking the first steps after getting out of bed or sitting for long periods
• Pain that eases slightly with movement but worsens again by the end of the day
• Increased discomfort when barefoot, in flat shoes, or in shoes without support
• Gradual worsening of pain over time

Causes of Achilles Tendinosis

Achilles tendinosis is a chronic condition caused by repetitive stress and micro tears in the tendon over time. The Achilles tendon, especially near its attachment to the heel, has limited blood flow, making it more susceptible to injury and slow healing. Without proper treatment, scar tissue forms, weakening the tendon and increasing the risk of further damage or rupture. The most common causes of Achilles tendinosis include:

• Repetitive stress or overuse: Activities like running, jumping, or sudden movements from a stationary position
• Limited tendon elasticity: Inability to stretch properly during movement, leading to micro tears
• Morning stiffness and pain: The tendon shortens while at rest, making the first steps of the day painful
• Muscle/tendon tightness (equinus): Common in toe walkers, those who wear high heels long-term, and ballet dancers
• Partial tears or ruptures: When improperly healed, these injuries can progress to chronic tendinosis
• Lack of proper healing: Untreated tendinosis can weaken the tendon, increasing the risk of full rupture

Diagnosing Achilles Tendinosis

Diagnosing Achilles tendinosis involves a thorough clinical examination and advanced imaging. Dr. Soomekh utilizes the following methods:

• Patient consultation: Discussing symptoms, concerns, and treatment goals
• Hands-on examination: Assessing the foot and ankle, checking for tendon damage, muscle involvement, and tendon shortening
• Gait evaluation: Analyzing movement patterns and biomechanical factors
• Digital X-rays: Identifying heel spurs or calcifications within the tendon
• Diagnostic state-of-the-art ultrasound: Providing a detailed view of tendon thickness, swelling, and any tearing to assess injury severity and treatment progress
• MRI (if needed): Ordered to evaluate the tendon in greater detail when a partial or full rupture is suspected

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Achilles Tendinosis Treatment Options

Dr. Soomekh emphasizes that early diagnosis and treatment are key to successful recovery and a pain-free lifestyle.

Conservative Treatment for Achilles Tendinosis

Conservative treatments aim to reduce pain, inflammation, and micro-tearing while improving tendon flexibility. Due to the chronic nature of the condition, these treatments may have limited success. Dr. Soomekh typically recommends an initial therapy protocol lasting two to four weeks.

Treatment may include:

• Ice therapy and anti-inflammatory medications (NSAIDs) to reduce pain and swelling
• Rest and restricted movement, often using a walking boot to minimize strain on the tendon
• A structured stretching regimen improves tendon elasticity and reduces micro-tears, particularly in the morning and after rest periods
• Heel lifts to reduce strain on the Achilles tendon
• Physical therapy to improve flexibility and strength

Custom Molded Orthotics

Custom orthotics help support the arch and heel, reducing strain on the Achilles tendon. By controlling motion through the heel, orthotics minimize stress on the tendon during walking and activity.

Cortisone (Steroid) Injections

Dr. Soomekh does not recommend cortisone injections for Achilles tendinosis, as they can weaken the tendon and increase the risk of rupture.

Advanced Treatments for Achilles Tendinosis

In chronic cases, the body’s natural healing response may be insufficient. Advanced treatments stimulate the tendon, break up scar tissue, and promote revascularization, converting the chronic injury into an acute inflammatory condition that the body can heal more effectively.

Platelet-Rich Plasma (PRP) Therapy for Achilles Tendinosis

PRP therapy uses the patient’s own platelets to accelerate healing. The process involves:

1. Drawing the patient’s blood and using a centrifuge to concentrate the platelets
2. Numbing the area and using ultrasound guidance to inject PRP into the Achilles tendon
3. Using a walking boot to protect the tendon during recovery

Some patients may require multiple PRP treatments for optimal results.

Percutaneous Topaz Coblation Therapy for Achilles Tendinosis

This minimally invasive procedure is performed in an operating room. Tiny holes are made through the skin, and a specialized probe is used to create controlled micro-injuries in the tendon. This triggers an inflammatory healing response while avoiding large incisions or significant scarring. A walking boot is used during recovery.

Tenex™ Percutaneous Tenotomy for Achilles Tendinosis

Surgical Treatment for Achilles Tendinosis

Dr. Soomekh prioritizes conservative treatment, but when pain becomes chronic and limits activity, surgery may be necessary.

Open Surgical Repair for Achilles Tendinosis

This Achilles tendinosis surgical procedure involves:

1. Making an incision along the Achilles tendon to access the damaged tissue
2. Removing scar tissue, damaged tendons, and any calcifications
3. Stimulating blood flow and healing using micro-incisions, PRP therapy, or Topaz Coblation therapy
4. Repairing the tendon with specialized sutures
5. Closing the incision using plastic surgery techniques for optimal healing