-That you have tried conservative therapy for 2-3 months before you even begin to consider surgery. Surgery comes with a great amount of risks and should not be attempted until conservative therapy is exhausted.
-Make sure that what you have been treating this entire time is actually Achilles tendinitis and not any other type of heel pain. If you are experiencing a sharp pain during your calf then you should consider following the guide for sharp pain in your Achilles Tendon.
If the case of achilles tendinitis is so resistant that the first two stages of treatment were ineffective, then you should likely go seek assistance from an experienced foot and ankle surgeon. We usually find that these cases include calcification of the tendon and spurring of the back of the heel and well into the Achilles tendon.
The surgical procedure would have to include detaching the Achilles tendon from the calcaneus, smoothing out the bone, smoothing out or resecting the calcified tissue and re-attaching the Achilles tendon to the calcaneal bone with bone and suture anchors.
The patient will also be evaluated for gastrocnemius or tendo-achilles lengthening to ensure proper length of the Achilles tendon and if they have equinus present (improper ankle motion which likely contributed or causes the Achilles problems in the first place)
Extracorporeal shock-wave therapy can also be tried to stimulated blood vessel growth, decrease nerve pain and attempt to break up the calcification through a “vibrations”
Radiofrequency coblation can also be attempted to increase blood vessel proliferation.