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Achilles Tendonitis

The Achilles tendon is the largest tendon in the human body. It is located at the back of the ankle joint and can be felt as a large, cord-like structure attaching to the back of the foot. Since tendons serve to attach muscles to bone, the Achilles tendon also attaches the large calf muscles, the gastrocnemius and soleus, to the back of the heel bone, the calcaneus.

Because of the large amount of stress which the Achilles tendon is subjected to during running and jumping activities, the Achilles tendon is prone to injury.

Achilles tendonitis tends to occur more frequently in older athletes than in younger athletes. As a person ages into their thirties and especially into their forties and fifties, the ligaments and tendons of the body tend to lose some of their stretchiness and are not as strong as before. This predisposes older individuals who are active in running and jumping activities, to tendon injuries such as Achilles tendinitis. However, Achilles tendonitis can also occur in teenagers who are very active in running and jumping sports.



Achilles tendonitis is diagnosed by a history and physical examination of the patient who describes pain at the back of the ankle with walking and/or running activities

During the physical examination, the physician will feel and push lightly around the Achilles tendon to see if it is tender or has any irregularities in its surface. Achilles tendonitis may cause the tendon to be thickened in areas, may cause swelling of the area around the tendon, and can even feel like the tendon has a painful bump on it. X-rays are not always helpful in diagnosing Achilles tendonitis so an MRI or Ultrasound may be ordered to better evaluate the tendon.



Most cases of Achilles Tendonitis can be treated conservatively with nonsurgical treatments, although it may take several months for symptoms to completely subside. This involves a number of modalities including:

  • Resting: The first step in reducing pain is to decrease the activities that aggravate one’s symptoms. Switching to low-impact activities until the acute inflammatory phase has passed will put less stress on the Achilles tendon.
  • Cross-training activities such as biking, elliptical exercise, and swimming are low-impact options to help you maintain being active.
    This can be done up to twenty minutes interval through the day as necessary.
  • Stretching exercises
  • Strengthening exercises with eccentric contractions of the Achilles.
  • Supportive shoes and Heel lifts
  • Custom-made orthotic devices,
  • Non-steroidal anti-inflammatory medications (NSAIDs): Drugs such as ibuprofen and naproxen reduce pain and swelling.


Two of the latest and most effective surgical management techniques are Tenex and Platelet Rich Plasma (PRP)

Platelet Rich Plasma PRP is derived from a patient’s own blood, which has been processed to concentrate the platelets. These concentrated platelets contain powerful growth factors that can jumpstart the healing of injured tendons and ligaments by stimulating tissue repair and regeneration. This procedure is done in conjunction with Tenex to maximize healing and repair of the Achilles Tendon.

Tenex is a minimally invasive procedure that uses high intensity ultrasound waves to identify and remove damaged collagen fibers and scar tissue that generate pain and inflammation in tendons.


How is the Tenex procedure performed?

The Tenex procedure involves the following steps:

  1. A local anesthetic is given to numb the affected area
  2. Ultrasound imaging identifies precisely the location of damaged scar tissue within the tendon
  3. A small incision is made to allow the pen shaped Tenex System to go in and break up the damaged scar tissue with the use of high-frequency vibrations, while not affecting the surrounding healthy tissue.
  4. The Tenex system gently removes the broken up scar tissue and an adhesive bandage is used to close the incision

How long does it take to recover from the Tenex procedure?

Recovery time is significantly reduced from several months (with traditional surgery) to only one to two weeks with the Tenex procedure. Most patients can begin light weight-bearing exercises within two weeks.

What are the benefits of Tenex treatment?

  • Chronic pain relief
  • Faster recovery time
  • Small incision
  • Decreased risks from complications of surgery or general anesthesia
  • Enabling patients to return to vigorous activities

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