Updated: Jun 6
This article discusses when surgery should be considered for ongoing Achilles tendon pain with a diagnosis of tendinopathy or tendonitis. Remember, if you need more help with an Achilles injury, you're welcome to consult one of our team via video call.
The terms tendinitis, tendonitis, tendinosis, and tendinopathy mean the same thing for all practical purposes, and we use these interchangeably in most of our articles.
In this article:
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Should I have surgery for my Achilles tendonitis?
There are many types of surgical options for Achilles tendon pain, using either arthroscopic (key hole) surgery or, less commonly, an open operation (a bigger incision). Surgery can be offered to you if your pain is continuing or worsening after having tried other treatment options.
It is important to note here that other non-surgical options like different types of injection therapies are commonly used before referring the patient to surgery.
The evidence available that compares surgical with non-surgical treatments in Achilles tendinopathy or tendonitis is limited, so little is known about the best time for surgery and indeed whether it has any benefits.
The analysis from a 2019 research study that did a thorough overview of the available research advocated that surgery should only be considered for selected cases if there was no benefit after 12 months or more of evidence-based Achilles tendon strengthening exercises.
What could I do instead of having surgery?
A tendon that has had persistent pain and problems for a long time is best treated by strengthening the Achilles tendon as well as the calf and other muscles further up the leg.
You may have tried exercises before and found that they haven't worked. This is often because they may have been too hard, too many, or indeed too easy. The exercises also need to be progressed (made more difficult as time goes on) to challenge the Achilles tendon and calf – making the tendon stronger and more robust so that it can withstand the amount of activity (load) you want to do, both day-to-day and with sport.
The 2019 study mentioned above indicated 12 months or more of evidence-based loading exercise as the best option for treatment. At TreatMyAchilles.com we also recognise the importance of load/activity management combined with evidenced-based exercises for the Achilles (and the rest of the body) as the most up-to-date treatment.
Load or activity management is also known as relative rest. Relative rest means you may reduce only the most aggravating activities so you can continue to train as the symptoms improve. Gaining advice on how to best do this is very important, as it will differ from person to person.
Surgery can be used for an Achilles tendinopathy or tendonitis, but is best used in a few select cases and only after individually prescribed exercises have been tried for 12 months or longer.
How we can help
Need more help with your Achilles injury? You’re welcome to consult one of the team at TMA online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Treat My Achilles we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author:
Challoumas, Dimitrios, et al. "How does surgery compare to sham surgery or physiotherapy as a treatment for tendinopathy? A systematic review of randomised trials." BMJ Open Sport & Exercise Medicine 5.1 (2019): e000528.