INTRODUCTION​

• There are multiple disease processes affecting the achilles tendon close to its insertion to the heel bone

• Achilles Tendinosis - Degeneration, not inflammation, of the achilles tendon resulting in pain and disability

• Achilles Retrocalcaneal bursitis- An inflammatory process where there is physical mechanical irritation of the bursa in front of the achilles tendon, a very painful process

• Achilles Paratenonitis- Inflammation of the lining or covering of the achilles tendon

• Insertional Achilles Tendinitis-An inflammatory process of the achilles tendon and the foot bone it inserts. Very painful and often associated with a haglund’s deformity, which is a bony prominence on the foot bone that contributes to pain

• 80-90% of patients with chronic achilles disorders improve with conservative management

CAUSES​

• Chronic achilles disorders have numerous causes. The most common causes include 

• Repetitive loading of the achilles tendon with ankle flexion and extension

• Restrictive shoewear

SIGNS AND SYMPTOMS

• Pain in the back of the heel over the achilles tendon or the heel bone

• Restrictive shoe wear due to irritation of the area of pathology

• Bony enlargement and pain at the heel bone

TREATMENT​​

• Treatment of chronic achilles disorders is highly personalized and numerous factors are taken into consideration including patient age, type of disorder, chronicity of injury, etc.

• The first line of treatment usually involves a course of physical therapy and a home exercise program focused on eccentric strengthening and stretching of the achilles tendon

• Anti-inflammatories such as ibuprofen are oftentimes helpful as an adjunct to other treatments

• Heel sleeves and heel pads can decrease pain and swelling

• Heel lifts help offload the achilles tendon

• Steroid injections are not recommended due to risk of achilles rupture 

• Chronic achilles tendinopathy that has failed conservative management may be treated with Platelet Rich Plasma (PRP) as there is growing evidence that this may help improve pain and avoid surgery 

• Surgery is reserved for cases that don’t improve after a course of conservative management if symptoms are significantly affecting activities of daily living and quality of life. 

PREVENTION  ​​

• Surgery is reserved for cases that don’t improve after a course of conservative management if symptoms are significantly affecting activities of daily living and quality of life.