Purpose: We report a series of 52 chronic Achilles tendinopathies. Surgical treatments included peritendon dissection, release of the fasia cruris, limited blunt combing of the tendon, and resection of nodules, calcifications and cysts as needed.

Material and methods: Mean duration of disease before treatment was 18 months. Twenty-six patients had sports activities. There were 12 bilateral cases. Pain was present in all cases. Ultrasonography was used to establish the PUDDU classification: paratendinitis 21, tendinitis 22, paratendinitis with tendinitis 9. All patients were reviewed at two years. Clinical criteria were used to assess outcome.

Results: Mean follow-up was five years six months. Complete pain relief was achieved in 29 cases. Motion was normal in 48 with recovery of former sports level in 29. Overall outcome was very good in 29, good in 14, fair in six and poor in three.

Discussion: The mean age of patients with poor outcome was relatively high. All the poor results were correlated with amyotrophy. The presence of a foot deformity did not appear to have an unfavourable effect on outcome. Infitration of the Achilles tendon should be avoided. Avoiding immobilisation appears to prevent tibiotalar stiffness. Ultrasonography can distinguish paratendinitis, tendinitis and paratendinitis with tendinitis but MRI offers very precise images of the lesions.

Conclusion: Surgical treatment of chronic Achiles tendinopathy can be proposed after failure of medical treatment. Outcome is better in younger subjects who participate in sports activities and who have paratendinitis.