Definition
Non-insertional Achilles Tendinopathy, also known as Achilles Tendinitis and Achilles Tenosynovitis, is a condition in which the middle part of the Achilles tendon becomes painful and swollen. Pain and swelling lower down the Achilles where it attaches to the heel bone is called Insertional Achilles Tendinopathy.
The exact cause of the problem is unknown but it is more common in men and in middle age. Overuse, excessive tightness of the calf muscles (gastro-soleus complex), poor blood supply to the area, malalignment of the leg or foot, various medical conditions and certain antibiotics may all contribute to the development of the problem.
Diagnosis
Your doctor can usually make the diagnosis from your symptoms and by examining your leg. X-rays are unlikely to be useful, but ultrasound or MRI scans can provide a detailed assessment of any structural damage inside the tendon.
Conservative Treatment
Most patients with non-insertional Achilles tendinopathy respond to non-surgical management.
Eccentric stretching exercises to reduce the tension in the calf muscles and help the tendon to heal are the mainstay of treatment for non-insertional disease and many patients recover with this treatment alone.
Extra Corporeal Shockwave Therapy combined with eccentric exercises can prove more effective than the exercises alone.
Other techniques such as Protein Rich Plasma injections, high volume saline injections and NSAIDs (anti-inflammatory drugs) are available but the evidence to support them is limited.
Surgical Treatment
If there is relatively little structural damage inside the Achilles, stripping of the soft tissue from the tendon by either an open or endoscopic (keyhole) technique may resolve the problem. This is usually combined with a release of the gastrocnemius (calf) muscle just below the knee if it is tight.
If there is more extensive structural damage inside the tendon it may be better to perform open surgery to debride (remove) the damaged areas and repair the healthy ones. In cases of severe tendon damage, a nearby tendon, FHL (flexor hallucis longus) can be used reinforce the Achilles.