Achilles Tendonitis

Inflammation of the Achilles tendon

Aetiology

  • Can occur due to repetitive strain (from sports) which leads to a peritendonitis or due to degenerative process with intrasubstance microtears

Risk factors

  • Overtraining (sports)
  • Quinolone antibiotics (ciprofloxacin)
  • Rheumatoid arthritis, gout and other inflammatory arthritis

Pathophysiology

  • Repetitive microtrauma, failure of collagen repair with loss of fibre alignments/structure
  • Hypovascular region 2-6cm proximal to insertion
notion image

Clinical presentation

  • Pain of the Achilles tendon or at its insertion in the calcaneus
  • Morning stiffness
  • Pain and stiffness eases with walking

Investigations

  • Clinical diagnosis
  • Can confirm with USS/MRI if uncertainty

Management

  • Activity modification, analgesia, NSAIDs
  • Physiotherapy
  • Heel raise to offload the tendon and use of a splint or boot
  • Resistant cases may benefit from tendon decompression and resection of paratenon however scars in this area can be problematic and the condition is usually self‐ limiting
  • Tendonitis predisposes to tendon rupture
  • Steroid injection should not be administered around the Achilles tendon due to risk of rupture