THE CLINIC: For Achilles Trouble, Surgery vs. Shock Wave Therapy
Thu, 27 Sept. 2012 - 12:37 a.m. MT
Credit: ARA Staff - American Running Association
I am suffering from tendonosis in the left Achilles tendon. I stopped running in July and started walking on flat surfaces. During this time, I went through intensive physical therapy. I was getting better but had a setback in the beginning of this month. The pain has become so intolerable that I cannot even walk. Now my orthopedist suggests trying shockwave therapy or surgery. What are your thoughts on both procedures? I am interested in the various benefits and risks of each. My goal is to run again; will this be possible?
ANSWER:The surgery is very straightforward. The sheath is stripped off the Achilles tendon to allow more blood to get to it. You may be able to bike and swim very soon after surgery. The shockwave therapy has a lower success rate. If I were in your situation I would opt for the surgery. It has been around for years and is tried and tested. You may return to distance running, but it will take 9 months to a year.
Robert C. Erickson, MD
ANSWER:Although there is no FDA indication, I would opt for the shockwave therapy if it is true Achilles tendonosis. Classic surgical debridement of the tendon and removal of underlying bone spurs can be a brutal recovery. Either procedure can risk rupture of the Achilles, but the chances are significantly greater with open surgery. Running is possible after both procedures, but I think you would need a minimum of 6 months to prevent reinjury, and likely longer with tendon debridement and possible lengthening. It is not unusual to lengthen an Achilles tendon, as a short tendon can be a cause of the tendonosis. Having shockwave treatment first does not preclude you from having the surgery later if necessary. Count on continued rehab after either track.
Ben Pearl, DPM, FACFAS
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(RUNNING & FITNEWS® November / December 2009 • Volume 27, Number 6)