What is Achilles Tendonosis and How Is It Treated?

person holding the back of their heelAchilles tendonosis is a degeneration of the collagen protein that forms the tendon. It typically occurs in response to chronic overuse without adequate time to heal and rest. When the tendon is damaged in this way, healing is haphazard and abnormal, resulting in pain when put under tension, stressed, or touched. This new tendon can be weaker, prone to re-injury and rupture if not adequately rehabilitated. The tendon will show up thicker on MRI.

Achilles tendonosis usually starts out as a milder condition called Achilles tendonitis. When treatment of Achilles tendonitis has not been complete it can progress to tendonosis. When the disorder progresses to degeneration, it can become enlarged and nodules can develop in the area where the tissue is damaged.

Signs and Symptoms

Patients with Achilles tendonosis will experience pain, tenderness, and stiffness without inflammation (swelling and redness) seen in Achilles tendonitis.

  • Tightness and loss of flexibility in the ankle.
  • Pain particularly after rest and upon wakening in the morning.
  • A nodule on the back of the heel
  • A jellylike consistency internally making the tendon soft and weak

Treatment and Prevention

Treatment and prevention are similar to those employed for Achilles tendonitis with special emphasis on curtailing all activities that put stress on the tendon. In addition, keep in mind:

  • Immobilization will be required to ensure the tendon gets adequate healing time
  • Ice may be of limited value since there is typically no inflammation in this condition. 
  • Regenerative medicine can help accelerate the healing process. These include:
    • PRP or Platelet-Rich Plasma
    • MLS laser therapy has been shown to work well in healing old injuries by bringing more blood floor to the site. It could be of important value in healing Achilles tendonosis.

Over time you'll receive this diagnosis which instead of inflammation results in a thickening of the tendon. Achilles tendinosis is progressive and degenerative.

When Achilles tendinosis is misdiagnosed, treatments for inflammation won't work. Physical therapists can end up providing inappropriate exercises that can make the problem worse. The best way to diagnose this problem is by MRI.

Fortunately there are treatments for Achilles tendinosis. Arch supports to correct biomechanical problems, immobilization with a boot, and proper stretching. Severe cases may require injections or surgery to prevent rupture.

For more information about Achilles tendonosis or to make an appointment, call the Foot and Ankle Center of Lake City at 206-368-7000 or request an appointment online.