Achilles tendinopathy

• Published in: South African general practitioner 2022-03, Vol.3 (1), p.22-25
• Main Author: Tabane, Ck
• Format: Article
• Language: English
• Subjects: Ankle; Antibiotics; Athletes; Body mass index; Bursitis; Diabetes; Exercise; Family physicians; Histology; Inflammatory bowel disease; Lithotripsy; Lupus; Magnetic resonance imaging; Pain; Pathology; Physical fitness; Tendinitis; Tendons; Ultrasonic imaging
• ISSN: 2706-9613; 2706-9621
• DOI: 10.36303/SAGP.2022.3.1.0109

Over the past decade, there has been an exponential rise in recreational sports; this has seen an associated increase in the incidence of Achilles tendon injuries, especially Achilles tendinopathy (AT). This is a degenerative process of the tendon without histological or clinical signs of intra-tendinous inflammation. It is the most frequent cause of heel pain, swelling and stiffness due to excessive loading of the tendon above its normal capacity. An interplay between both intrinsic (e.g. age, sex, foot abnormalities and increased body mass index) and extrinsic (e.g. sudden increase in training load and poor training technique) aetiological factors are important considerations. Fluoroquinolone-induced AT is a specific entity that the primary care physician should be aware of, especially in those at risk of AT, advanced age, and poor renal function. AT can also manifest in chronic conditions like diabetes, inflammatory bowel disease and systemic lupus erythematosus. Pain and swelling that is aggravated by physical activity, and stiffness after prolonged immobility are diagnostic of AT, with clinical tests only confirming the presence of tenderness, swelling and reduced plantar flexion. Both ultrasound and MRI are useful in aiding the diagnosis by showing the tissue changes. Management, which is primarily conservative and is effective, includes the use of anti-inflammatories in the short term, and advocating the use of orthotics, stretching, eccentric exercises and shock wave therapy in the long term. Surgical modalities like tendon transfer, tenotomy, debridement and repair, are recommended for those not showing clinical improvement in six months of conservative management.