by Smith CM

Achilles Tendonopathy

(Achilles Tendonitis; Achilles Tendonosis)

Definition

Tendons connect muscle to bone and often connect near a joint. Tendonopathy is an injury to the tendon. It can cause pain and swelling and makes it difficult to move. Tendonopathy may be:
  • Tendonitis—inflammation of the tendon
  • Tendonosis—tiny tears in the tendon with no major inflammation
The Achilles tendon connects the calf muscle to the heel bone. An achilles tendonopathy is pain in this tendon.
Achilles Tendonitis
Achilles Tendonitis
Copyright © Nucleus Medical Media, Inc.

Causes

Tendinopathy is generally caused by overuse of a muscle-tendon unit. Over time, the strain on the tendon causes structural changes within the tendon.
Overuse of the Achilles tendon can occur with activities such as:
  • Increasing your speed or running long distances too quickly
  • Suddenly adding strenuous hills or stair climbing to your exercise routine
  • Doing too much too soon after taking time away from exercising
  • A sudden or violent contraction of the calf muscles, such as during an all-out sprint
  • Running too much
  • Lack of flexibility of the calf muscles

Risk Factors

Achilles tendonopathy is more common in older adults due to the aging process. Factors that may increase your risk of getting Achilles tendonopathy include:
  • Improper or badly worn footwear
  • Inflexibility of the calf muscles
  • An improper training program—such as increasing intensity too quickly

Symptoms

Symptoms of tendonopathy may include:
  • Tenderness—usually just above the heel bone and often more noticeable in the morning
  • Stiffness that gradually eases as the tendon is warmed-up
  • Pain after activity that gradually worsens
  • Pain along the tendon during and/or after running
  • Swelling in the area of the Achilles tendon
  • Pain at the back of the ankle

Diagnosis

You will be asked about your symptoms and exercise habits. A physical exam will be done. A diagnosis will be made based on the exam and history.
Images of the bones and tendons may be taken. This can be done with:

Treatment

Tendinopathy and the associated pain may take months to resolve. It can be frustrating, but it is important to follow through with the advised treatment.

Supportive Care

The tendon will need time to heal. Treatment may include:
  • Restricting activities
  • Ice therapy to help relieve swelling
  • A shoe insert that places the foot in the correct position
  • Ankle taping to support the area
Prescription or over-the-counter medications may be advised to reduce pain.

Physical Therapy

A physical therapist will assess the tendon. Ultrasound and/or massage may be done to help relieve tension.
An exercise program will be created to help recovery and to strengthen the calf muscles.

Prevention

To decrease your chances of getting Achilles tendonitis:
  • Wear appropriate footwear for your sport.
  • Do not use shoes beyond the advised duration. This will depend on:
    • How frequently you exercise
    • The surface on which you exercise
    • The conditions in which you exercise
  • Gradually add hill work, stairs, speed, and distance to your routine.
  • Stretch and strengthen the calf muscles regularly.

RESOURCES

American College of Sports Medicine
http://acsm.org
OrthoInfo—American Academy of Orthopaedic Surgeons
http://orthoinfo.org

CANADIAN RESOURCES

Canadian Orthopaedic Association
http://www.coa-aco.org
Canadian Orthopaedic Foundation
http://www.canorth.org

References

Achilles tendinopathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 29, 2014. Accessed March 2, 2015.
Achilles tendinitis. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00147. Updated June 2010. Accessed March 2, 2015.
Common disorders of the achilles tendon. American College of Foot and Ankle Surgeons Foot Health Facts website. Available at: http://www.foothealthfacts.org/footankleinfo/achilles-tendon.htm. Accessed March 2, 2015.
de Jonge S, van den Berg C, de Vos RJ, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026-1028.
Irwin TA. Current concepts review: insertional achilles tendinopathy. Foot Ankle Int. 2010;31(10):933-939.
10/26/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Massey T, Derry S, Moore R, McQuay H. Topical NSAIDs for acute pain in adults. Cochrane Database Syst Rev. 2010;(6):CD007402.

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