Skip to Main Content

++

  • Achilles tendinitis
  • Achilles tendonitis
  • Achilles paratenonitis

++

  • 726.71 Achilles bursitis or tendonitis

++

  • M76.60 Achilles tendinitis, unspecified leg

++
++

Description

++

  • Insertional Achilles tendinitis: fibers in middle portion of the tendon breakdown, degenerate, swell, thicken
  • Noninsertional Achilles tendonitis: pain in lower portion of heel at tendon attachment
  • Pain common at midportion of Achilles tendon
  • Typically lacks presence of inflammatory cells, probably more tendonosis then tendonitis
  • Typically associated with tissue degeneration
    • Two types
      • Lipoid: fatty tissue deposited in the tendon
      • Mucoid: conversion of tendon in softer material with gray or brown appearance
    • Thickening of tendon
    • Neovascularization
    • Increased presence of varicose nerve fibers
      • Most likely source of pain

++

Essentials of Diagnosis

++

  • Patient history and clinical examination
  • Ultrasound or MRI imaging

++

General Considerations

++

  • Address training errors and biomechanics deficits to prevent recurrence

++

Demographics

++

  • People participating in athletic activity; condition can also occur in sedentary individuals
    • Runners: 7 to 9% prevalence4
  • Age: between 30 to 50 years of age (median)4
  • Sex: Males more than females4
  • Onset more common during training vs. competitive event

++

Signs and Symptoms

++

  • Pain with palpation of tendon 2 to 6 cm proximal to the insertion
  • Pain back of the heel
  • Tenderness changes position with tendon movement during dorsiflexion and plantarflexion (arc sign)
  • Increased swelling throughout the day
  • Thickening of the tendon
  • Decreased dorsiflexion range of motion (ROM)
  • Decreased gastrocnemius strength
  • Greater pronation/calcaneal varus and faster rate of max. pronation
  • Decreased plantar flexion strength and endurance verse uninvolved side

++

Functional Implications

++

  • Inability to climb stairs or ladder
  • Inability to push-off during ambulation
  • Decreased stride length during ambulation

++

Possible Contributing Causes

++

  • Intrinsic risk factors
    • Decreased dorsiflexion ROM
    • Decreased gastrocnemius strength
    • Greater pronation/Calcaneal varus and faster rate of max. pronation
    • Comorbidities
    • Obesity
    • Diabetes
    • Hyperlipidemia
    • Hypertension
  • Extrinsic risk factors
    • Training errors
      • Sudden increase in mileage or intensity or incline
      • Return from inactivity
    • Environmental factors
      • High incidence with training in cold weather
    • Faulty equipment

++

Differential Diagnosis

++

  • Achilles tendon rupture
  • Achilles tendon partial tear
  • Bone spur
  • Sural nerve pathology
  • Retrocalcaneal bursitis
  • Posterior ankle impingement
  • Accessory soleus muscle
  • S1 radiculopathy
  • Achilles tendon ossification
  • Achilles enthesopathy
  • Os trigonum
  • Systemic inflammatory disease
  • Xanthoma of the tendon: accumulation of cholesterol in patients with familial hypercholesterolemia

++

Imaging

++

++

  • Hypertrophic tendon
  • Hyperechoic mass at midtendon
  • Irregular tendon structure

++

  • Medication
    • NSAIDs
    • Prolotherapy: sclerosant injection (most common dextrose)

++

Medical Procedures

++ ++

  • Orthopeadic ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.