Achilles tendinopathy
Epidemiology & Risk Factors
Overuse/running/jumping sports; sudden increase in training volume/intensity.
Medications : Fluoroquinolones (e.g., ciprofloxacin), systemic corticosteroids.Associated conditions : Seronegative spondyloarthropathies (enthesitis), familial hypercholesterolemia (xanthomas), DM.
Clinical Features
Burning posterior heel pain and stiffness (worse in AM and after exercise; improves with light activity).
Midportion tendinopathy (most common): Tenderness/swelling 2–6 cm proximal to calcaneal insertion.Insertional tendinopathy : Pain directly at calcaneal attachment ± Haglund deformity.Negative Thompson test (intact plantarflexion on calf squeeze).
Diagnosis
Initial / Primary : Clinical diagnosis via H&P.Ultrasound (US) : Thickened tendon, hypoechoic degenerative areas, neovascularization.MRI (Gold Standard / Confirmatory) : Increased T1/T2 signal; evaluates partial vs. full-thickness tears.X-ray : Normal or shows calcaneal spur/calcification (rules out avulsion or stress fracture).
Differential Diagnostics
Calcaneal Apophysitis (Sever Disease) : Diff by occurrence in skeletally immature pediatric/adolescent athletes (ages 8–12) during growth spurts; pain localized over the posterior calcaneal apophysis with (+) calcaneal squeeze test .Achilles Tendon Rupture : Sudden “pop” or “gunshot” sensation, palpable gap, (+) Thompson test .Plantar Fasciitis : Inferior/plantar heel pain, worse with first morning steps.Calcaneal Stress Fracture : Pain with calcaneal squeeze test (medial-lateral compression).Retrocalcaneal Bursitis : Pain on two-finger palpation anterior to the Achilles insertion.
Management
First-line :
Relative rest, activity modification, ice, temporary heel lifts.
Physical therapy : Eccentric loading exercises (mainstay of rehab).Short-term oral NSAIDs for acute pain control.
High-Yield Contraindication : NO local glucocorticoid injections (high risk of tendon rupture ).Refractory (>3–6 months) : Extracorporeal shock wave therapy (ESWT) or surgical debridement.
Complications
Achilles tendon rupture (partial or complete).Chronic debilitating pain and altered gait biomechanics.
