Non-insertional Achilles tendinopathy: What it is and how the surgery works
SmartHallux® Method
Smarthallux explains to you
All you need to know
on non-insertional Achilles tendinopathy
What does non-insertional Achilles tendinopathy mean?
Non-insertional Achilles tendinopathy often affects the sports patient at all levels.
age and the non-athletic patient over 45 years of age. It is characterized by pain in the Achilles tendon in its portion between 3 and 6 cm above its insertion on the heel.
The Achilles tendon is the largest and strongest tendon in the human body. It is formed by the union of the gastrocnemius and soleus muscles, which join together to form the Achilles tendon that inserts into the heel, the posterior portion of the calcaneus.
This is a very important pathology that should not be underestimated because it can predispose to the risk of rupture of the Achilles tendon.
Many factors have been called into play for the genesis of this pathology including vascular, biomechanical factors, use of steroids or certain antibiotics, malalignments, heterometry of the lower limbs, loss of elasticity.
Non-insertional Achilles tendinopathy: diagnosis
A specialist visit is essential to make a diagnosis.
The specialist, simply by observing the patient walking barefoot and performing some specific tests, is able to reach a diagnosis.
To decide on the patient's therapeutic path, the doctor uses magnetic resonance imaging (MRI) to evaluate the degree of degeneration of the tendon fibers.
Conservative management of Achilles tendinopathy depends on the patient's symptoms, the extent of the process, and the patient's functional demands. In the early stages, the use of an insole during sports activities to improve foot physiology, a period of rest, the use of anti-inflammatory medications, specific eccentric exercises, and Tecar Therapy can improve symptoms.
However, all these measures often represent a temporary solution, therefore indicated only in patients with low functional demands or with contraindications to surgery.
Non-insertional Achilles tendinopathy: therapy
Treatment for tendinopathy aims to treat inflammation of the Achilles tendon and reduce the risk of rupture. There are several treatments for Achilles tendinopathy, including:
• Rest and ice : This is the first line of treatment for Achilles tendinopathy. Rest helps reduce stress on the tendon, and ice helps reduce pain and treat inflammation of the Achilles tendon.
• Stretching and strengthening exercises : These exercises help improve flexibility and tendon strength.
• Physiotherapy : Physiotherapy can help improve the flexibility, strength and function of the Achilles tendon and reduce inflammation and correct any postural and muscular deficits
• Steroid injections : Steroid injections can help reduce pain and inflammation, but they are not a long-term solution and can lead to complete tendon rupture.
• Growth factor, PRP and stem cell injections : Injections of growth factors, PRP and stem cells can reduce inflammation and reduce the risk of complete tendon rupture
• Surgery : Surgery is an option for severe cases of Achilles tendinopathy that do not respond to other treatments.
The goal of treatment for Achilles tendinopathy is to improve the quality of the tendon, reduce pain, and as a therapy for Achilles tendinosis.
The goal of SmartHallux
SmartHallux's goal is to revolutionize the treatment of Achilles tendinopathy and all foot and ankle conditions. To achieve this goal, we adopt the best surgical techniques, orthopedic devices, instruments, and materials available on the market.
This is why we offer private healthcare at an accessible and financeable cost.
Unfortunately, public and private healthcare systems have spending limits that limit the use of materials, equipment, and facilities.
With SmartHallux you will have access to the best possible treatments, in excellent facilities and without having to wait for public health authorities. Surgical techniques have undergone an important evolution compared to the past, starting from anesthesia and post-operative pain control.
Non-insertional Achilles tendinopathy: anesthesia
The anesthesia we use at SmartHallux does not involve painful ankle injections or uncomfortable spinal anesthesia, nor does it require general anesthesia. Using ultrasound guidance, our anesthesiologists are able to identify the nerves and, with a single injection behind the knee, selectively numb the nerve structures necessary and sufficient to perform the procedure painlessly, leaving the patient with full leg mobility and bladder control. Sedation allows the patient to avoid anxiety and, often, wake up immediately after the surgery.
This type of anesthesia also allows for anesthesia to be prolonged for up to 24-48 hours, reducing or even eliminating postoperative pain, without any risks or contraindications. Only if it is necessary to harvest stem cells from abdominal fat is it associated with spinal anesthesia.
Our surgical techniques
The surgical technique we use at SmartHallux does not involve incisions, but rather four small "holes" that leave no scars. These four portals eliminate all adhesions between the tendon and the subcutaneous layer and Kager's adipose triangle, simultaneously improving vascularization and eliminating pain.
Then taking advantage of the most effective and modern regenerative medicine techniques, stem cells taken from abdominal fat, gluteal fat or the pre-patellar region are then injected into the tendon.
SmartHallux uses the highest-quality disposable materials to guarantee maximum sterility and dramatically reduces the risk of transmitting infectious diseases and metallosis (the dispersion of metal debris into tissues, which can lead to chronic inflammation) compared to reusing burs. Disposable materials also ensure greater cutting precision and are environmentally friendly, as they do not require resterilization, thus saving water and electricity.
Duration of the intervention
The operation is generally performed in day surgery. The patient enters the hospital in the morning and returns home the same evening.
Back to activities
The day after surgery, when sensation is fully recovered, the patient can walk with full support of the foot, wearing a comfortable shoe.
The only restriction remains driving vehicles for 7 days.
The first check-up is performed approximately 15 days after surgery to assess the condition of the wounds. The absorbable stitches fall out on their own. Full recovery generally occurs 2-3 months after surgery, although the regeneration process takes up to 12 months. The patient can return to contact sports after 2-3 months.
Complications and risks of the surgery
Risks and complications associated with surgery are very rare, especially with non-invasive surgery. They include bleeding, allergic reactions, infections, deep vein thrombosis, embolisms, and skin complications, nerve damage with loss of sensation, persistent pain around the scar, and joint stiffness.
The use of antibiotics and low molecular weight heparin further reduces the risk of complications.
Why choose SmartHallux for surgery?
Our doctors, led by Dr. Manzi, have extensive experience in treating Achilles tendinopathy, with a very high percentage of satisfied patients.
The secrets of our success lie in the use of the best surgical and anesthesiological techniques, and the use of cutting-edge, top-quality materials.
Waiting times for Achilles tendinopathy surgery through the National Health Service (NHS) can be very long, varying from region to region and from facility to facility. In some cases, the wait can be several months or even years. SmartHallux offers the opportunity to access the procedure more quickly, avoiding long waiting lists.
Regarding costs, Achilles tendinopathy surgery can vary depending on the technique used, the complexity of the case, and the healthcare facility where it is performed. Typically, the average cost is around €10.000. At SmartHallux, thanks to the advanced technique used and our collaboration with several clinics, you can obtain a significantly more competitive price.
SmartHallux® Certified Clinics
Our offices
San Camillo Nursing Home - Via Mauro Macchi, 5, 20124 Milan MI
UPMC Salvator Mundi International Hospital V.le delle Mura Gianicolensi, 67, 00152 Rome RM
Ruesch SPA Clinic Viale Maria Cristina di Savoia, 39, 80122 Naples NA
Smarthallux Netherland - Statenplein 21 - 2582 EZ Den Haag
SmartHallux United Kingdom - Cromwell Hospital 164-178 Cromwell Rd, London SW5 0TU, United Kingdom
Smarthallux Madrid - Calle de Hermosilla 95 - 28006 – Madrid Spain
FAQ
The prognosis for Achilles tendinopathy is generally good. Most people who follow a comprehensive treatment program recover from Achilles tendinopathy. However, healing takes time, and you may need to make lifestyle changes to prevent further injury.
There are several options for booking a consultation with Dr. Manzi.
Dr. Manzi visits medical practices that collaborate with SmartHallux located in Rome, Milan and Naples
It is also possible to book a telemedicine visit.