Achilles Tendinopathy

Achilles tendonitis:
Up to 20% of running injuries.

Predisposing factors:
Increase in sports activity; change of sports surface; change of footwear; worn footwear; poor biomechanics; tight calf muscle; age.
Fluoroquinolones (eg ciprofloxacin) increase risk of tendon injury

Overuse injury – cumulative impact loading and/or repetitive microtrauma
Seronegative spondyloarthropathy (enthesopathy)

Clinical features:
Usually gradual onset; worse in morning and start of activity; may palpate thickness/swelling at site of tenderness. Most common site is 2-6cm above insertion

Grade 1: Pain only after running
Grade 2: Pain before and after running and gradually worsens during run
Grade 3: Pain on activity that restricts level of activity
Grade 4: Pain during non-sports activity

Grades 1 – RICE; heel raise; stretching; eliminate predisposing factors. Grade 2 – add reducing of pain and inflammation; eccentric strengthening; activity modification; correct biomechanics. Grade 3 – add electrotherapeutic modalities; soft tissue therapy (transverse friction); greater rest; strapping to prevent dorsiflexion. Grade 4 – add significant rest; surgery if no response
NSAID’s are not indicated for achilles tendinopathy

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