ACHILLES TENDINITIS

🔰History

■ Mechanism
➣ Overuse, muscle imbalance, poor exercise biomechanics
■ Initial complaints
➣ Pain, swelling, decreased activity tolerance
■ Chronic complaints
➣ Pain with activity, difficulty running and jumping
➣ Swelling
■ Common in runners

🔰Physical exam

■ Acute

➣ Diffuse swelling, pain with palpation, pain with dorsiflexion
➣ Lateral pain – Associated with supination
➣ Medial pain – Associated with pronation

■ Chronic

➣ Pain, decreased dorsiflexion, atrophy
➣ Longitudinal swelling rather than well localized
■ Classification
➣ Insertional vs. non insertional studies

■ Radiographs

➣ AP, lateral, mortise views (lateral most important)
➣ Radiographs generally normal
➣ Calcifications, traction spurs – Degenerative changes, degenerative changes or partial tear

■ MRI

➣ Tendinitis – Peritendinous fluid/edema, no tendinous signal
changes
➣ Differential diagnosis using MRI
■ Tendinosis (intrasubstance signal changes)
■ Partial tear
■ Retrocalcaneal bursitis

🔰Differential diagnosis

■ Achilles tendinosis
■ Partial tear
■ Haglund’s deformity
■ Retrocalcaneal bursitis

🔰Treatment

■ Nonoperative
➣ Types of nonoperative treatment
➧ Immobilization (cast, walking boot)
➧ Heel lift
➧ Anti-inflammatory medications
➧ Achilles stretching
➧ Physical therapy (including ice massage)
➧ Steroids contraindicated due to risk of rupture

■ Operative
➣ Debridement if refractory to conservative measures
➣ Lysis of adhesions

Disposition
N/A

🔰Prognosis

■ Pure tendinitis without associated tendinosis usually responds well to conservative measures.
■ Surgical results for insertional Achilles tendinitis are worse than those for non insertional Achilles tendinitis.

■ Long-term complications

➣ Tendon ruptures after steroids by mouth or injection
➣ Chronic swelling or pain can result even after debridement

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