The goal of treatment of patients with chronic complaints of midportion Achilles tendinopathy
is to relieve pain. Many surgical procedures focus on the debridement of alterations in the
tendon proper. Since up to 34% of asymptomatic tendons show histopathological changes,
it is now believed that the tendon proper is not the cause of pain in the majority of patients
with symptomatic midportion Achilles tendinopathy. Chronic painful tendons show ingrowth
of sensory- and sympathetic nerves from the paratenon with release of nociceptive substances.
Denervating the Achilles tendon by release of the paratenon, is sufficient to cause
pain relief in the majority of patients. This type of treatment has the additional advantage
that it is associated with a shorter recovery time when compared to treatment options that
address the tendon itself.
New minimally invasive techniques of stripping of neovessels from the Kager’s triangle of the tendo Achillis have been described, and seem to allow faster recovery and accelerated return to sports, rather than open surgery