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Achilles Tendon Disorders

Tendonitis and Tendosynovitis

ICD 10 - M76.60

The Achilles tendon is a powerful tissue and the largest tendon in the body which connects the muscles of the calf to the heel. The Achilles tendon is responsible for generating force to push off the foot and for lifting the foot to be able to clear the ground when walking. Achilles tendon disorders include: Achilles tendonitis, Achilles paratenonitis and Achilles tendinosis. Tendonitis is an inflammation of the tendon. Paratenonitis is an inflammation of the sheath that covers the inner surface of a tendon and a type of tendonitis. Tendinosis is the chronic deterioration of the collagen inside of the tendon frequently due to repeated use and abuse.

Achilles tendon disorders can be classed in 2 types::

• Type I: Noninsertional Achilles Tendon Disorder: Inflammation and tears of the tendon occur higher up in the middle portion of the Achilles.
• Type II: Insertional Achilles Tendon Disorder: Inflammation and tears of the tendon occur near the heel or calcaneus.

These 3 disorders are generally the result of overuse and sudden repetitive excess stress applied onto the Achilles tendon. These stresses cause microtears in the tissue which do not cleanly repair due to excess overuse worsening the symptoms and condition. Athletes, people prone to overpronation during physical activity and the elderly are more likely to develop these conditions.  

Symptoms:

Tendinitis:

• Inflammation of the Achilles tendon
• Localized pain during physical activity and in general daily activity
• The result of having or having had prior paratenonitis or tendinosis

Paratenonitis:

• Formation of nodules in the tendon
• Inflammation and swelling of the tendon
• Initially, pain only during athletic activities, but increases to general daily activity as the pathology progresses.

Tendinosis:

• Localized pain and thickening of tendon
• Increased weakness of tendon
• Reduced plantarflexion capacity

Diagnosis:

Diagnosing a patient with any of these disorders will include a physical examination and palpation of the tendon by the physician to assess the local pain, strength, thickening and swelling of the tendon. X-rays may be useful for assessing bone spurs. MRIs and ultrasound can be ordered to check for the degree of tearing or degeneration in the tendon.

Treatment:

Tendonitis, Paratenonitis and Tendinosis can be treated with NSAIDs, rest, stretching, ice and/or orthotics. Recovery may take some time especially if the damaged part of the Achilles tendon has poor blood circulation. Easier treatment is more likely for patients that have only recently developed the overuse injury or disorder. Physical therapy or lower extremity braces may be considered needed after 2-3 months if little recovery is seen, and surgery may be considered an option after 6 months of little recovery.

Sources:

https://www.foothealthfacts.org/conditions/achilles-tendon-disorders 
https://orthoinfo.aaos.org/en/diseases--conditions/achilles-tendinitis/ 
https://footcaremd.org/conditions-treatments/ankle/achilles-tendinitis 
https://footcaremd.org/conditions-treatments/ankle/achilles-tendinosis 
https://www.podiatrytoday.com/article/39 
https://www.rehabmypatient.com/ankle/achilles-tendon-rupture