Joint Preservation Blog

December 15, 2008

achilles tendon tear bursitis

The Achilles tendon is the cord that connects the calf muscle (gastrocnemius) to the heel bone (calcaneus).  This transmitts force to the foot for “toe off” in normal walking.  An Achilles tendon tear bursitis is when the tendon gets a partial tear (not through and through, but strecthed or torn a bit) and the bursa (lubricating sac between the tendon and the calcaneus bone) gets inflammed.  This bursitis can cause pain and is usualy from too much force on the tendon.  The cause of this problem is usually altered bio mechanics.  This means that things like excessive tightness in the claf muscle, too much weight on that side of the body, or even issues with range of motion of the hip or knee joints are overloading the achilles tendon.

The most traditional way to treat this is with a steroid injection into the busa.  While this can reduce the swelling in the bursa and some of the pain, it can also destroy the body’s ability to heal the tendon tear.  Steroids will reduce the activity of the body’s own stem cells it uses for repair.  Smarter ways to fix this problem would start with changing the biomechanics to reduce over load in this region.  Orthotics may help, as well as loosening the muscles in the calf and around the knee or hip joints.  Once that’s accomplished, newer non-surgical methods to treat this problem are now available.  These include prolotherapy injections into the tendon area.  These injections are used to cause a brief inflammatory healing reaction in the tendon.  While these may help, they can only rarely help strengthen the tendon in our experience.  The issue is that the Achilles tendon is such a big and dense tendon, getting the prolotherapy medicine into the tendon can be difficult.  In addition, accessing the exact area of the bursitis without x-ray guidance is almost impossible.  A newer alternative is the injection of the patient’s own stem cells into the bursa area under x-ray guiance.  This allows the stem cells to turn into new tendon material and strengthen the tendon and reduce the bursitis.  For information on this technique, see the link at the front of the first paragraph above.  This newer stem cell tecnique avoids surgery and allows for high activity levels after the procedure, unlike surgery which usually requires at least a walking boot for immobilization.

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