When Do I Need Surgery For Achilles Tendonitis?

Most Achilles tendonitis can be healed with nonsurgical treatments. But, sometimes the pain persists despite these conservative treatments. You still have pain in the back of your heel that is worse with activity, standing, and walking. Do you need surgery for Achilles tendonitis? And what are your surgical options for Achilles tendonitis?

Surgery is only used as a last resort for Achilles tendonitis. However, some patients don’t heal with conservative treatments for Achilles tendonitis, and surgical options are available.

What is Achilles tendonitis?

Achilles tendonitis is inflammation and partial tearing of the Achilles tendon. This is typically an overuse injury. 

Achilles tendonitis can occur at the heel (insertional Achilles tendonitis) or 1-2 inches above the heel (midsubstance Achilles tendonitis). 

What are surgical options for midsubstance Achilles tendonitis?

If you have persistent pain 1-2 inches above the heel and have failed nonoperative treatment for Achilles tendonitis, there are surgical options for patients. 

General anesthesia is used, and patients are placed face down during surgery. An incision is made over the Achilles tendon. All of the diseased part of the tendon is removed. The remaining, non-damaged tendon is sewn up. The foot is splinted with the toes pointed down for 2 weeks. 

What are surgical options for insertional Achilles tendonitis?

If the Achilles tendonitis is at the heel bone, the surgery is a little different. The surgery still requires general anesthesia and being face down. The Achilles tendon is removed from the calcaneus, and all unhealthy tendons are removed. Then, the bone spur from the heel bone is removed, and any bony prominences are smoothed. Any inflammation around the area is removed. Finally, the Achilles tendon is repaired to the heel bone. A splint with the foot pointed down is used for 2 weeks. 

The orthopedic surgeons at Southwest Orthopedic Group and Dr. Stautberg can review your specific surgical options for Achilles tendonitis. 

What surgical options are available if my  Achilles is completely worn out?

In a small percentage of patients, the Achilles tendon is completely worn out and degenerative. In these cases, the Achilles may not be able to be repaired. To fix this problem, a tendon transfer is used. One of the tendons that flexes the big toe can be transferred into the heel to become the new Achilles tendon. 

What is the recovery from Achilles tendonitis surgery?

Unfortunately, the full recovery can take some time. We have to treat patients as if they tore their Achilles tendon. They are nonweightbearing in a splint or a boot for a period of time. Sutures are usually removed in 2 weeks. Then, patients are allowed to walk in a boot with heel wedges. Physical therapy is used to aid in recovery.

What are surgical outcomes for Achilles tendonitis?

Overall, the success rate for Achilles tendon surgery is 80-90%. There is a spectrum of final results based on the patient’s baseline function and how much the tendon has degenerated. 

The surgeons at Southwest Orthopedic Group and Dr. Stautberg can review all of your specific goals and will design nonsurgical and surgical options for your Achilles tendonitis. 

The American Orthopaedic Foot & Ankle Society (AOFAS) has more information about Achilles tendonitis at FootCareMD.

For more questions or to set up an evaluation, contact Dr. Stautberg’s office at 281-977-4870. 

Author

Eugene Stautberg, MD