Achilles Tendinopathy

NONINSERTIONAL ACHILLES TENDINITIS

In noninsertional Achilles tendinitis, fibers in the middle portion of the tendon have begun to break down with tiny tears (degenerate), swell, and thicken.

Tendinitis of the middle portion of the tendon more commonly affects younger, active people.

INSERTIONAL ACHILLES TENDINITIS

Insertional Achilles tendinitis involves the lower portion of the heel, where the tendon attaches (inserts) to the heel bone.

In both noninsertional and insertional Achilles tendinitis, damaged tendon fibers may also calcify (harden). Bone spurs (extra bone growth) often form with insertional Achilles tendinitis.

Tendinitis that affects the insertion of the tendon can occur at any time, even in patients who are not active.

Causes

Achilles tendinitis is typically not related to a specific injury. The problem results from repetitive stress to the tendon. This often happens when we push our bodies to do too much, too soon, but other factors can make it more likely to develop tendinitis, including: 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

Tight calf muscles — Having tight calf muscles and suddenly starting an aggressive exercise program can put extra stress on the Achilles tendon

Bone spur — Extra bone growth where the Achilles tendon attaches to the heel bone can rub against the tendon and cause pain

Symptoms

Symptoms of Achilles tendinopathy include pain along the back of the lower leg by the Achilles tendon, loss of performance and function, thickening of the tendon which can often be felt.

Treatment

Procedural options for chronic tendon dysfunction include regenerative-type injections (such as platelet-rich plasma [PRP] or stem cell injections) that can theoretically provide long lasting pain relief and improved function by stimulating the body’s own natural healing response.  There is some evidence that needling the tendon alone can stimulate bloodflow and healing. A procedure called Tenex can be done under ultrasound as well which uses a small oscillating needle to debride (suck out) the damaged parts of the tendon.

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