The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel (the calcaneus bone). Flexion of the calf muscles pulls on the Achilles and causes plantar flexion of the ankle.
Achilles tendinopathy involves damage, swelling, inflammation and reduced function in the Achilles tendon.
There are two types of Achilles tendinopathy:
- Insertion tendinopathy (within 2cm of the insertion point on the calcaneus)
- Mid-portion tendinopathy (2-6 cm above the insertion point)
Risk Factors
- Sports that stress the Achilles (e.g., basketball, tennis and track athletics)
- Inflammatory conditions (e.g., rheumatoid arthritis and ankylosing spondylitis)
- Diabetes
- Raised cholesterol
- Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin)
Presentation
The typical presentation is with a gradual onset of:
- Pain or aching in the Achilles tendon or heel, with activity
- Stiffness
- Tenderness
- Swelling
- Nodularity on palpation of the tendon
Management
Achilles tendinopathy is a clinical diagnosis and does not usually require any investigations to diagnose. It is essential to exclude Achilles tendon rupture, for example, using Simmonds’ calf squeeze test. Ultrasound is used to diagnose Achilles tendon rupture.
Management options are:
- Rest and altered activities
- Ice
- Analgesia
- Physiotherapy
- Orthotics (e.g., insoles)
- Extracorporeal shock-wave therapy (ESWT)
- Surgery, to remove nodules and adhesions or alter the tendon, may be used where other treatments fail
Steroid injections into the Achilles tendon are avoided due to the risk of tendon rupture.
Last updated August 2021
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