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Achilles Tendinopathy

Ryan Evans
Mar 23, 2023
1 min read

General term to describe degeneration of the Achilles tendon, either mid-tendon or insertional. Tendinopathy causes pain, swelling, and impaired performance.


Risk Factors

  • Age

  • Anatomical Deformities

  • Diabetes

  • Hypercholesterolemia

  • Hyperuricaemia

  • Inflammatory conditions

  • Sudden increase in load

  • Chronic comorbidities

  • Smoking

  • Footwear

  • Medication (Corticosteroids, Quinolone Antibiotics, Statins, Aromatase Inhibitors)


Symptoms

  • Pain around the tendon and tender to touch.

  • Stiffness – improved with movement.

  • Increased pain after activity.

  • Localised swelling. Crepitus (rare)


Treatment

Exercise Program

  • Must be slowly progressive.

  • Isometric – for early pain relief.

  • Eccentric – Best evidence for main strengthening.

  • Plyometrics – for return to sports.

Education

  • Load management.

  • Expected response to exercise.

  • Pain relief – Medication, Cold therapy, Elevation.

  • Managing Expectation – Not a quick fix.

  • Discuss evidence base.

Other

  • Steroid Injections (Evidence to cause future issues)

  • Platelet Rich Plasma Injection (low evidence)

  • Electrotherapies (low evidence)

  • Surgery in severe cases (Evidence suggests similar outcomes to exercise)


Differential Diagnosis

  • Os trigonum syndrome

  • Fractures

  • Partial Rupture

  • Impingement

  • Meniscal tears

  • Patellofemoral pain syndrome

  • Avascular necrosis

  • Subluxation

  • Instability

  • Tendinous Issue

Other

  • 4.0% of patients with a previous diagnosis of Achilles tendinopathy subsequently sustain ruptures.



1. NICE. (2020), Achilles tendinopathy: What are the risk factors?. Available from: https://cks.nice.org.uk/topics/achilles-tendinopathy/background-information/risk-factors/. [Accessed March, 2023.]

2. Yasui, Y., Tonogai, I., Rosenbaum, A., Shimozono, Y., Kawano, H., Kennedy, J., and Zhang, H. (2017), ‘The Rist of Achilles Tendon Rupture in the Patients with Achilles Tendinopathy: Healthcare Database Analysis in the United States’, BioMed research international, Vol. 2017, pp.7021862-4.

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