What Is Achilles Tendinosis?

In contrast to achilles tendinitis (acute inflammation), achilles tendinosis refers to degeneration of the achilles tendon over time, leading to chronic pain. Achilles tendinosis classically occurs in two distinct areas of the tendon, most commonly at the insertion into the heel bone (calcaneus).

Surgical management is most frequently performed for insertional achilles tendinosis. There are multiple causes of pain in this condition, and all are addressed through the same incision at the time of surgery.

What Dr Smith Addresses During Surgery

Three components are typically treated through a single incision at the back of the heel:

  • Achilles tendinosis — degenerative tissue within the lower end of the tendon is removed to eliminate this pain source
  • Haglund deformity — excessive bone formation at the back of the calcaneus (heel bone), which irritates the tendon and the adjacent bursa and can be particularly painful when rubbing on shoes. This bony prominence is removed at the time of surgery.
  • Retrocalcaneal bursitis — the bursa sitting behind the heel bone and in front of the achilles tendon becomes inflamed and painful. The inflamed tissue is removed through the same incision.

Surgical Technique

The procedure involves making an incision directly over the bony prominence at the back of the heel. The achilles tendon is partially reflected from its insertion into the calcaneus. Any diseased portions of the tendon are removed, the excessive bony prominence is excised, and the inflamed bursa is cleared. The achilles tendon is then re-secured to the calcaneus using strong suture anchors.

Recovery and Rehabilitation

Patients commence weight bearing once their wounds have healed (2–3 weeks following the procedure) with the addition of a post-operative boot. A wound review is performed at 2 weeks, after which a structured rehabilitation program begins with dedicated sports physiotherapists:

  • Progressive range of motion exercises and strengthening program
  • Calf and peroneal strengthening
  • Proprioceptive and balance training as healing progresses
Early mobilisation after surgery is associated with improved function and faster recovery. Most patients notice significant improvement in pain within weeks of the procedure.