Successful Treatment Of Persistent Post-operative Achilles Tendon Pain - Page #1

Author: Michael Stiller, MD
Co Author #1: Michael Baria, MD, MBA
Editor: Leena Patel, DO
Senior Editor: Margaret Gibson, MD

Patient Presentation:
The patient is a 35-year-old male two years status-post left Achilles tendon debridement and repair that was performed for Achilles tendinopathy without tendon rupture. He experienced persistent post-operative pain and presented to the clinic for further evaluation and treatment.

His pain was located in the proximal half of the Achilles tendon region, was non-radiating, described as a constant ache, rated 5/10 in intensity, and was provoked by any load-bearing activity. Physical therapy, including eccentric strengthening, topical diclofenac, and dry needling failed to improve his symptoms. There were no fevers, chills, night sweats, erythema, or focal neurologic deficits.

Physical Exam:
Ankle and foot alignment was normal. A well-healed incision without erythema or dehiscence was noted. The Achilles tendon had a moderate amount of swelling from the gastroc-soleus musculotendinous transition down to the calcaneal insertion. The tendon was diffusely tender to palpation, with maximum tenderness at the site of the musculotendinous junction. Palpation of Kager's fat pad was non-tender. The Thompson calf squeeze test produced normal plantarflexion. Resting tone of the Achilles was symmetric.

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