Achilles Tendinopathy
Achilles Tendinopathy
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Achilles tendinopathy is a common disorder that can cause pain, stiffness, swelling and weakness of the Achilles tendon. It supports and absorbs the body’s weight while walking and running and can sometimes become over worked resulting in pain and discomfort. Achilles tendinopathy is usually categorized into either insertional or non-insertional pain. These require different treatments for a successful recovery.
Patient Signs and Symptoms
Patient Signs and Symptoms
Pain in the back of the heel (at Achilles Tendon insertion site / radiating up tendon)
More noticeable in morning (goes away as tendon warms up)
Pain aggravated by activity
Gradual onset of symptoms
Possible decrease in strength & movement
Possible thickening of tendon
Significant Findings
Significant Findings
Swelling along the Achilles tendon or at the back of your heel
Thickening or enlargement of the Achilles tendon
Bony spurs at the lower part of the tendon at the back of your heel
The point of greatest tenderness
Pain at the back of your heel at the lower part of the tendon
Limited range of motion—specifically, a decreased ability to flex your foot
Rupture:
Important not to be missed
Rupture:
Important not to be missed
If rupture is suspected this requires urgent referral to Orthopaedics
Sudden sharp pain (patient may describe a “pop”)
Sudden loss of strength & movement Inability/ difficulty walking on tip toes
Positive (Simmonds/Thompson) squeeze test (squeezing calf muscles should cause plantarflexion of foot, if the foot fails to plantarflex it could be considered a positive test)
Positive Matles test
Imaging
Imaging
Not indicated at initial assessment unless history of trauma or to suspect osteomyelitis, however x-ray has low sensitivity and specificity for detecting acute osteomyelitis.
Diagnosis made by clinical signs as typically indicates accurate diagnosis.
Imaging maybe used at later date, can be discussed at our MSK Podiatry Virtual Escalation clinic as required on presentation.
Preferably weight bearing views in lateral, Dorsal/ Plantar and Oblique.
Common presentation on X-ray are:
Enthesophyte formation at the Achilles tendon insertion or calcification/ossification within the distal Achilles tendon
Common Causes
Common Causes
A sudden increase in the amount or intensity of exercise activity. For example, increasing the distance you run every day by a few miles without giving your body a chance to adjust to the new distance may cause irritation and inflammation.
Tight calf muscles. Calf muscle tightness puts extra stress on the Achilles tendon, especially where it inserts into the heel bone.
Haglund's deformity. This is a condition in which there is enlargement of the bone on the back of the heel. This can rub on the Achilles tendon and cause inflammation and pain.
Differential Diagnosis
Differential Diagnosis
Sever’s Disease (child)
Plantar Fasciitis
Bursiitis
Posterior heel impingement (Os Trigonum)
Haglund's deformity
Calcific Achilles tendinopathy
Enthesopathy
First line treatment options
First line treatment options
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