Achilles Tendinopathy

• 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
• 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 for Achilles tendinopathy

  • 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)
• The typical presentation of Achilles tendinopathy

  1. Gradual onset of pain or aching in the Achilles tendon or heel with activity

  2. Stiffness

  3. Tenderness

  4. Swelling
• Conditions associated with Achilles tendinopathy

  • Rheumatoid arthritis and ankylosing spondylitis
  • Diabetes
  • Raised cholesterol
  • Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin)
• Diagnosis of Achilles tendinopathy

  1. Clinical diagnosis

  2. Exclusion of Achilles tendon rupture using Simmonds’ calf squeeze test

  3. Diagnosis of Achilles tendon rupture using ultrasound
• Management options for Achilles tendinopathy

  • 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
  • Steroid injections into the Achilles tendon are avoided due to the risk of tendon rupture
• Last updated

  August 2021