Achilles Tendinopathy

Your achilles tendon is a very important structures which is responsible in helping you walk and gives power to your step. Achilles tendinopathy refers to a condition characterized by pain, swelling, and impaired function of the Achilles tendon. It is a common overuse injury that affects the Achilles tendon, which connects the calf muscles to the heel bone.

Several factors can contribute to the development of Achilles tendinopathy, including:

1. Overuse or repetitive stress: Engaging in activities that involve repetitive movements, excessive running, jumping, or sudden increases in training intensity can strain the Achilles tendon and lead to tendinopathy.

2. Poor biomechanics: Abnormal foot mechanics, such as flat feet, high arches, or improper running or walking techniques, can place excessive stress on the Achilles tendon.

3. Inadequate warm-up or stretching: Failing to properly warm up before physical activity or neglecting to stretch the calf muscles can increase the risk of Achilles tendinopathy.

4. Training errors: Rapidly increasing the duration, intensity, or frequency of activities without allowing the tendon sufficient time to adapt can contribute to tendinopathy.

5. Age: Achilles tendinopathy is more common in individuals over the age of 30, as the tendon's ability to withstand stress and regenerate decreases with age.

Achilles tendinopathy is typically categorized into two main types:

• Insertional - Occurs at the site your tendon inserts into your heel bone

• Non-insertional - Occurs about 2-3 cm up your tendon as it is an area with poorer blood supply

Insertional Achilles Tendinopathy

Non-operative treatment options for insertional tendinopathy includes:

1. Simple pain relief

2. Rest and ice

3. Physical therapy of eccentric calf exercises

4. Shoe-wear modification

5. Shockwave therapy

Operative intervention is very successful for this condition and includes:

• Detachment of the achilles tendon and debridement of the calcified insertion site

• Excision of the Haglunds (bony spur) lesion

• Removal of the bursae (inflammatory fluid sacs)

• Reconstruction of the tendon

Non-Insertional Achilles Tendinopathy

Non-operative options for non-insertional tendinopathy includes:

1. Simple pain relief

2. Rest and ice

3. Physical therapy of eccentric calf exercises

4. Shoe-wear modifications

5. Hydrodilation - Fluid injection into tendon sheath

6. Shockwave therapy

7. GTN patches

Operative intervention can be successful if the above has failed and depends on the amount of tendon involved:

• If less than 50% - tendon debrided and repaired side to side

• If more than 50% - diseased tendon debrided and tendon reconstructed