Achilles Tendon Injuries

Introduction

  • Pain of the Achilles tendon commonly affects both competitive athletes and the sedentary

  • The Achilles tendon is the largest tendon in the body

  • Injury can occur from overuse, vascular disease, neuropathy (nerve problems), rheumatologic disease, and injuries from activities such as running, jumping and sudden acceleration or deceleration.

  • The hallmark of Achilles tendon problems is damaged, weak, inelastic tissue

Terminology

  • Terms used to characterize acute or chronic tendon pain include:

    • tendonitis​

    • tendinosis

    • tendinopathy

    • paratendonitis

    • enthesopathy

    • insertional tendonitis

  • The term "tendonitis" is confusing because inflammation is often not seen on histopathology (under the microscope)

  • Pain where the achilles tendon attaches to the calcaneus (heel bone)

  • Occurs in patients with a tight heel cord

  • Repetitive trauma leads to infammation followed by cartilagenous then bony changes within the tissue

  • X-rays can sometimes show 

  • Posterior heel pain, burning, and stiffness

  • Sometimes a bony "bump" can be seen on the back of the heel

  • Usually normal but can show a bone spur and calcification within the tendon

  • Can help to evaluate the extent of the damage (degeneration)