Skip to Main Content

202: ACHILLES TENDINOPATHY

Josh A. Barabas, MPT, OCS, CSCS; Christina L. Pettie, MHA, PT

CONDITION/DISORDER SYNONYMS

  • Achilles tendinitis

  • Achilles tendonitis

  • Achilles tendinosis

ICD-9-CM CODE1

  • 726.71 Achilles bursitis or tendonitis

ICD-10-CM CODE2

  • M76.60 Achilles tendinitis, unspecified leg

PREFERRED PRACTICE PATTERN3

  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

PATIENT PRESENTATION

A 37-year-old man presents complaining of pain in his left heel. Pain began 3 weeks ago when he increased his total running distance from 20 miles per week to 40 miles per week. He indicates pain worsens with running and stair climbing. Palpation reveals tenderness in the middle portion of his Achilles tendon. Examination reveals he is lacking 15 degrees of passive dorsiflexion compared to his uninvolved side and is unable to perform greater than five single leg calf raises due to pain. The patient tests negative for neural dynamics tests of the lower extremities.

KEY FEATURES

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 the Achilles tendon

  • Typically lacks presence of inflammatory cells, probably more tendonosis than tendonitis

  • Typically associated with tissue degeneration

    • Two types

      • Lipoid: Fatty tissue deposited in the tendon

      • Mucoid: Conversion of the tendon in softer material with gray or brown appearance

    • Thickening of the tendon

    • Neovascularization

    • Increased presence of varicose nerve fibers

      • Most likely source of pain

FIGURE 202-1

Achilles tendinitis. (A) Photograph of a patient with a prominence in the area of the posterior superior aspect of the calcaneus. (B) Lateral view radiograph of same patient demonstrating that an insertional calcific Achilles tendinitis, not Haglund deformity, is the cause of this deformity. (From Imboden J, Hellmann DB, Stone JH. Current Diagnosis & Treatment in Rheumatology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

image
View Full Size||Download Slide (.ppt)
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 and 50 years of age (median)4

  • Sex: Males more than females4

  • Onset more common during training versus competitive event

CLINICAL FINDINGS

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 ...

Pop-up div Successfully Displayed

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

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close