Achilles Tendinopathy

Achilles tendinopathy (Achilles tendinitis/tendonitis or Achilles tendinosis) is a combination of pain, swelling, and impaired performance in the achilles tendon or supporting tissues. Achilles tendinopathy may be a chronic degenerative condition resulting from poor blood supply and micro damage over time, an acute traumatic condition resulting from overloading of the tendon, or a combination of the two.

Paratenonitis
The paratenon itself is inflamed and thickened. There is capillary proliferation and infiltration of inflammatory cells within the paratenon. Localized pain and burning occurs during or following activities. As the disease progresses, onset of pain may occur earlier during activity or even at rest.

Tendinosis
There are thickened, yellowish, areas of mucoid degeneration within the tendon itself. Hypocellularity, collagen disorganization, lack of inflammatory reaction, scattered vascular ingrowth, and intermittent areas of calcification or necrosis are common. Tendinosis usually occurs 2-6 cm proximal to the insertion at the calcaneus, in the "watershed area," an area of poor blood supply and slow healing capacity. This condition may be asymptomatic and noninflammatory.

Paratenonitis with Tendinosis
Activity related pain and swelling of the tendon sheath with nodularity is present. This condition combines signs and symptoms found in both paratenosis and tendinosis.

Tendon Rupture
Full or partial tendon rupture may result from end-stage paratenosis.

Causes and Risk Factors

 * Chronic degeneration
 * Overloading the tendon
 * Sudden changes in activity
 * Inappropriate footwear
 * Improper training
 * Age over 35
 * Oversupination
 * Overpronation
 * Tibia vara
 * Hindfoot and/or forefoot varus deformities
 * Lack of flexibility
 * Obesity

Incidence

 * There is an estimated incidence of Achilles tendinitis in 6.5-18% of runners

Symptoms, Signs and Tests
See "Classifications of Achilles Tendinopathy" above.

Treatment
===Acute Treatment Phase (From onset until pain is relieved)  === The goal of this phase is to rest and potentially immobilize the tendon to reduce pain and allow the tendon to heal. Methods for this phase include:

Orthotic Treatment

 * Temporary 3/8"-5/8" heel lift to reduce stress on the tendon
 * Walking boot to immobilize the tendon
 * Night splint to prevent the tendon from tightening

Other Treatment

 * NSAID's
 * Cryotherapy

Postacute Treatment Phase
The goal of this phase is to stretch and strengthen the tendon to increase the functional capacities of the Achilles tendon to prevent future overuse and overloading injuries. If overpronation may have been a factor, it will be addressed in this phase. Methods for this phase include:

Orthotic Treatment

 * Semirigid foot orthoses to prevent overpronation or oversupination
 * Switching to minimalist shoes to keep the tendon stretched

Other Treatment

 * Physical therapy
 * Eccentric strength training
 * Proper training techniques
 * Regular stretching and strength training regimens

Prognosis
The recovery time is generally weeks to months. There is a longer recovery time with tendinosis. Recurrences are common.