Disorders of the Achilles tendon represent a common cause of foot pain and dysfunction. Anatomically, the Achilles tendon inserts on the calcaneus or heel bone. The Achilles tendon forms the insertion of the gastrocnemius and soleus muscles. The gastrocnemius, which originates above the knee, and the soleus, which originates on the back of the tibia, are located in the posterior leg or calf. These muscles function to plantarflex the foot which enables us to push off when we walk or run. The Achilles tendon is encased in a thin, vascular layer of tissue called a paratenon.
The Achilles tendon is subject to a variety of overuse type syndromes. Paratenonitis refers to a painful condition characterized by inflammation of the paratenon. Tendinosis refers to a degenerative condition of the tendon itself. The term “tendonitis”, when used in reference to the Achilles tendon, is a misnomer because the tendon undergoes a degenerative rather than an inflammatory process.
Patients affected by Achilles tendon dysfunction typically are young athletes or older active individuals. Diagnosis is made by a careful history and physical examination. Patients may report pain or tightness anywhere along the course of the Achilles tendon from the musculotendinous junction to the calcaneus insertion. Pain more commonly occurs with activities such as running or walking. Physical examination will show tenderness to palpation of the tendon. Swelling of the tendon may be present. Dorsiflexion of the ankle may be restricted and may be associated with pain. Plain radiographs (x-rays) are usually normal but may show a bony prominence at the calcaneus insertion site. Ultrasound and MRI scanning are useful tools for diagnosis and planning treatment in these disorders.
Treatment for Achilles tendinopathy is usually non-operative. On occasion, a period of immobilization in a molded ankle-foot orthosis is used. Anti-inflammatory medication can be helpful. Physical therapy for gentle stretching and modalities has been used with success. For athletes, a change in training regimen may be necessary to alleviate symptoms. A heel lift may be beneficial for some patients. Rarely is surgery performed to excise the diseased tendon or paratenon. In order to properly diagnose and treat Achilles tendon dysfunction, an evaluation by an orthopedic surgeon is recommended.
