Achilles tendon issues commonly include
Tendinopathy, characterised by degenerative changes and chronic pain due to overuse, and
Acute ruptures, which involve a complete or partial tear of the tendon fibres typically following a sudden increase in stress or trauma.
Paratenonitis, an inflammation of the tissue surrounding the tendon, and
Insertional Achilles Tendinopathy, where degeneration occurs at the tendon’s attachment to the calcaneus.
Management varies depending on the specific pathology, with conservative approaches prioritised initially but surgical intervention considered in refractory or severe cases.
Introduction
Achilles tendinopathy is a prevalent overuse injury affecting the tendon connecting the calf muscles to the heel bone. This condition is particularly common among athletes and physically active individuals, causing pain and functional impairment that can limit mobility and performance. Understanding the nature, causative factors, and clinical presentation of Achilles tendinitis is crucial for timely diagnosis and effective management.
What is Achilles Tendinopathy? Is it the same as Achilles Tendonitis?
Achilles tendinitis is an inflammation of the Achilles tendon, the largest and strongest tendon in the body. It typically results from microtears and degenerative changes within the tendon structure caused by repetitive stress.
Medically, it is classified as a tendinopathy encompassing both acute inflammatory and chronic degenerative processes.
Histopathological studies reveal collagen disorganisation, increased ground substance, and neovascularisation, indicating a failure in the tendon’s normal healing response.
The condition predominantly affects the mid-portion of the tendon, although insertional Achilles tendinitis involves the tendon’s attachment to the calcaneus.
Why Do People Get Achilles Tendinopathy?
Achilles Tendinopagty develops due to a combination of intrinsic and extrinsic factors that increase strain on the tendon.
Common causes identified in the literature include:
Overuse and repetitive strain: Sudden increases in physical activity, especially running or jumping, overload the tendon beyond its capacity.
Biomechanical abnormalities: Conditions such as overpronation of the foot, leg length discrepancy, and tight calf muscles alter tendon loading patterns.
Age-related degeneration: Tendon elasticity decreases with age, making older individuals more susceptible.
Improper footwear and training surfaces: Shoes lacking adequate support and running on hard or uneven surfaces exacerbate tendon stress.
Medical conditions: Systemic diseases, such as diabetes and rheumatoid arthritis, and the use of certain medications (e.g. fluoroquinolone antibiotics, corticosteroids) impair tendon integrity.
Sudden changes in activity intensity or technique: Rapid increases in exercise intensity or alterations in running form elevate injury risk.
Common Signs and Symptoms of Achilles Tendinopathy
Patients experiencing Achilles tendinitis typically present with a constellation of characteristic clinical features:
Pain and stiffness: Initial symptoms often include mild pain and stiffness at the back of the heel, which worsens with activity, especially in the morning or after periods of rest.
Tenderness: Localised tenderness along the tendon, particularly 2-6 cm above the heel insertion, is common on palpation.
Swelling and thickening: Symptoms include swelling or thickening of the tendon as a result of inflammation or chronic degeneration.
Reduced strength and flexibility: Affected individuals often report weakness in plantarflexion and diminished calf muscle flexibility.
Crepitus: A sensation of crackling or creaking may be felt during tendon movement.
Functional impairment: Pain typically increases during weight-bearing activities such as running, jumping, or climbing stairs, occasionally causing significant disability.
In summary, Achilles tendinitis is an overuse condition characterised by tendon inflammation and degeneration, precipitated by multifactorial causes including biomechanical stress and systemic factors. Recognition of key symptoms such as pain, tenderness, and functional limitation aids in early diagnosis and intervention, ultimately improving patient outcomes.