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Achilles Tendinitis / Tendinosis

(see also: Achilles Tendon Rupture)LEG24A

Discussion

  • while there are many causes of posterior ankle pain, there are two distinct conditions which may affect the Achilles tendon:
    • tendinitis and tendinosis, each having a distinct prognosis;

Tendinitis / Tendinosis

  • peritendinous inflammation which does not generally progress to degenerative tendinosis (nor rupture);
  • in other situations, there will be clinical inflammation, but objective pathologic evidence for cellular inflammation is lacking, and
    • in these conditions the term tendinosis is more appropriate;
    • degenerative process which can occur w/o signs of inflammation (mucoid degeneration);
    • teninosis may be related to region of diminished blood supply just above the tendon insertion;
    • often the tendinosis remains subclinical until it presents as a rupture;
  • often results from training errors in adults in their 30s and 40s;
  • most commonly affects runners;
  • heel cord contracture will exacerbate the patient's symptoms;
  • on exam, patients generally have no strength deficit and do not have tenderness to deep palpation;
  • two forms of the condition are recognized (insertional and non-insertional);

non-insertional

insertional tendinitis

Work Up

diff dx

exam

  • deep palpation will elicit tenderness;
  • there may be palpable nodularity in the tender aspect of the tendon;
  • weakness is evidenced by inability to raise up on toes;

radiographs

  • may show calcification within the Achilles tendon, which may indicate a more proximal tendinosis;

MRI

  • may be indicated in cases of tendinosis with suspected multiple partial tears;

Treatment

Achilles Tendon Debridement

FHL Transfer

References