Updated: Oct 26, 2021
This blog investigates if and when surgery should be considered for on-going Achilles tendon pain with a diagnosis of tendinopathy / tendinitis / tendonitis.
In this article
Should I have surgery?
What should I do?
Should I have Surgery?
There are many types of surgical options for Achilles tendon pain using either arthroscopic (key hole) or, less commonly, an open operation (a bigger incision). Surgery can be offered to you if your pain is continuing or worsening after trying 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 to surgery.
The evidence available that compares surgery and non-surgical treatments in Achilles tendinopathy or tendonitis is limited, so little advice about the best time or indeed the benefits of surgery is known.
The analysis from a 2019 research article that reviewed current research advocated that surgery should only be considered for selected cases if there was no benefit after 12 months or more of evidence-based loading exercises.
What should I do?
A tendon that has had persistent pain and problems in it for a long period of time is best treated by strengthening the Achilles and calf and other muscles further up the leg.
You may have tried exercises before and found that they haven't worked and 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 it stronger and more robust so that it can withstand the amount of activity (load) you want to do, both day to day and with running.
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 can also be 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.
Take Home Message
Surgery can be used for an Achilles tendinopathy or tendonitis, but is best used in a few select cases and only after individualised prescribed exercises have been tried for 12 months or longer.
Let me know if you have any questions. Need more help with your Achilles injury? You can consult us online via video call for a tailored treatment plan. Video calls are great, because they allow us to see you move and perform all the test movements just like we would do in a regular clinic.
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.