Achilles tendinopathy
Achilles tendinopathy is activity-related posterior heel pain and tenderness 2 to 6 cm above the calcaneal insertion, diagnosed clinically and managed first with eccentric loading exercise rather than rest alone.
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What this article covers
- Overview
Achilles tendinopathy is a chronic overuse condition of the Achilles tendon, most commonly affecting the midportion 2 to 6 cm proximal to the calcaneal insertion, producing activity-related posterior heel pain, stiffness, and tenderness.
- Epidemiology
Common cause of hindfoot pain, second only to plantar fasciitis among conditions producing posterior/plantar heel pain in the general population.
- Risk factors
Sudden initiation or abrupt increase in running, jumping, or other repetitive loading activity, the classic precipitant described in overuse tendinopathy.
- Pathophysiology
Repetitive submaximal loading produces cumulative microtrauma that outpaces the tendon's capacity to remodel, initiating a cycle of collagen microtearing and disorganized repair.
- Clinical features
Activity-related posterior heel pain and stiffness that improves with rest, the hallmark and defining pattern; pain that is present with the first steps in the morning or after inactivity and eases…
- Differential diagnosis
Achilles tendon rupture (partial or complete): an acute pop, loss of plantar flexion strength, a palpable tendon gap, and a positive Thompson test distinguish rupture from tendinopathy's gradual onset and preserved strength.
- Diagnosis
Achilles tendinopathy is a clinical diagnosis established by activity-related posterior heel pain with focal tenderness of the tendon 2 to 6 cm above the calcaneal insertion (midportion) or directly…
- Management
First, modify or temporarily reduce the aggravating activity (running mileage, jumping volume) rather than complete rest, since some controlled loading accelerates tendon remodeling better than immobilization.
- Complications
Progression to complete or partial Achilles tendon rupture: the most serious complication of unaddressed or heavily loaded tendinosis, particularly if a corticosteroid injection has been given into the tendon.
- Prognosis
Most patients with midportion Achilles tendinopathy improve substantially with a 12-week eccentric loading program, with the majority returning to prior activity levels.
- Prevention
Gradual, progressive increases in running mileage or training intensity, avoiding abrupt jumps that precipitate overuse tendinopathy.
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