Achilles tendinopathy is a condition that causes pain, swelling, stiffness and weakness of the achilles tendon. It is thought to be caused by repeated minor trauma to the achilles tendon, which fails heal completely. This means that over time Achilles tendinopathy can develop. Achilles tendinopathy can be insertional and non-insertional. This condition was previously referred to as Achilles Tendonitis.
Achilles tendinopathy is an overuse injury which may be caused by: short calf muscles, over pronation of the foot ( the foot rolls in and flattens the arch leading to increased twisting stress up the leg), sudden increase in activity, inadequate warm up prior to activity.
Insertional Achilles tendinopathy occurs where the tendon inserts into the heel bone (calcaneus) and can be associated with posterior heel spurs and calcification of the tendon.
Non-insertional Achilles tendinopathy usually occurs between 2-6 cm from the insertion point into the calcaneus.
Diagnosis can established with clinical signs and can be confirmed by an Ultrasound scan.
Treatment
Treatment options include rest, ice packs, anti-inflammatorys, physiotherapy, immobilisation, orthotic insoles with heel raise, therapeutic ultrasound, ESWT and cortisone injections under Ultrasound guidance. Cortisone injections around the Achilles tendon are controversial as they can provoke rupture of the tendon, if given they should be performed under ultrasound guidance to ensure the tendon itself is not injected. If conservative measures fail surgical intervention may be considered. Shockwave therapy ESWT has been used more recently to help stimulate neo-vascularisation and promote tissue healing.
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