After a long hot and trying summer – I could not outrun my achilles tendonitis. A new MRI revealed that the tendon simply was not in condition to get better on its own. There was substantial long term inflammation and poor healing in the tendon. Dr. Armendariz recommended debridement and PRP.
He also said that the amount of damage may indicate the need to relocate a tendon! That would involve moving the extensor tendon which controls what essentially is curling your big toe down. They cut it proximal to the ankle and attach it to the back end of the achilles tendon to act as reinforcement. This was not exactly something I was expecting to hear. He said some big toe flexion would be lost but the other toes and rest of the foot would not be effected and I indeed would resume running once again regardless. He also said he would not know if it was necessary until he got inside… so it would be a “game day decision”.
The procedure is done in an outpatient surgery center. Interesting that the first time I had achilles tendon surgery (calcaneotomy) in 1982 I was in the hospital 3 days! This time – in @ 0600 and home by 1030!!!!
I had anesthesia and popliteal nerve block. The block lasted about 36 hours – basically leaving below my knee mostly numb; the discomfort rose after 36 hours.
My brother Jim was at the helm guiding my post-op activities and recovery. I did not talk to doc afterwards (or if I did I was too out of it to remember anything said) but Jim did. The good news was that the tendon relocation was not necessary! Woohoo!!!
What they did:
After they opened up the tendon sheath doc then did the debridement. This is done by strategically “burning” multiple locations along the tendon which will initiate a healing response which in turn builds the tendon stronger than its former condition.
PRP (platelet rich plasma) is then injected into the tendon in multiple locations. The PRP is drawn from me and then injected into me. This is all done during the surgery.
PRP is a newer procedure for treating tendons. It has had excellent results in the literature and I now know 3 local runners who have had the PRP for various tendon issues – all are back 100%. They draw blood and then extract your own platelets to be re-injected into the effected site. The exact mechanisms on how this works seems to be not entirely understood. It enhances healing – especially in poorly vascularized areas i.e. tendons. The downside to this procedure is that it is NOT covered by most insurance plans at this time. So beware! Though my surgery was covered by insurance the PRP was not.
I actually took my first pain medications on Monday evening. I simply could not do anything to get comfortable. I also decided to change dressing due to wetness and smell (OK, doc said not to touch it until I saw him 10 days post-op but my nursing instincts took over. I was not leaving a wet dressing on).
As you can see the incision is about 8″ which was a bit shocking since he originally intended about 4″.
I have to wear a walking “cam” boot 24/7 for the first 10 days until my first post-op appointment. I can have only partial weight bearing and use crutches to get around. I will then wear the boot for about 4 more weeks at which time rehab begins. During this time I can remove the boot at night and for showering etc.
The doc says the prognosis is good and he anticipates full recovery and I will be back running once again.