TA probs that just wont go away

[physiogeneve]

From what I can understand the tendon has been ultra sound scanned and reviewed structually and functionally. The feeling is a tendon that is so short is affecting the biomechanics of the foot and the fear is that firstly it will rupture if they try to "chemically" break down the fibrous tissues and secondly it is compromising the bursae/synovial tissue.

In all honnesty I feel the pain cycle has to be broken and so far manual techniques have not done this. I always think very carefully before surgical intervention but may be in this case with a good surgeon and proactive rehab post op we will see a change. The jury for me is out on this one. I hope the procedure correlates with a reduction in pain. I will update the forum with the outcome.

[physiobob]

Yep I agree. I suppose wish her luck. One would have thought that a good old heal raise would have worked if one considers that the lengthening procedure would as well? That said the structural issues with tendinosis are still unclear:- less type 1 collagen, proliferation of blood vessels into the tendon structure, increase neural sprouting into the same etc. The research I believe has shown then pain can be present with and without any of the aforementioned issues and so no one is considered to account for chronic pain.

I think what we do know is that these tendons functionally are weak. She may or may not also have neural issues and trigger points in the soleus and surrounding structures. If she were mine I would make a deal that we would first of all really go to town on the strengthening aspect with proper weights training/ weighted jacket to get the tendon behaving more like a tendon. I would work on any trigger issues as the same time, I would ice following every workout and I would record pain levels using a simple VAS (visual analogue scale). Only after this fails would I resort to surgery but that should be with a solid rationale for what they are going to do and why?

Seems like she may have tried the above so lets see what the surgery discovers? Tell her she is a great case study for us all right now