Achilles Tendonopathy

By Michael DeChello, MS, PT

The achilles tendon is the continuation of the gastrocsoleus complex of muscles and inserts on the calcaneous or heel. The gastrocsoleus originates above the knee making it a multi joint mover. It has a direct impact on the knee, ankle and subtalar joint in the foot. Recently the term tendonopathy has become the lump-all category for tendon pathology. This term includes early stage tendonitis, paratendonitis and later stage chronic tendonitis. Chronic tendon pain usually does not have inflammatory changes in the affected tendon, but rather degenerative changes. Achilles tendon disorders are divided into three zones: 1) non-insertional 2) tendon insertion and 3) at the muscle tendon interface or junction which is more proximal. The approach to treatment is conservative initially with rest to decrease the strain on the tendon. In some cases a walking boot may be required. The use of modalities such as ultrasound, electric stimulation, cross friction massage, heel lifts and ice may be helpful. After pain is reduced, a gradual return to activities while monitoring symptoms is necessary, progressing to strengthening exercises. In some cases custom fit orthotics may be helpful as a prevention option.

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