Achilles tendinitis and peritendinitis: Etiology and treatment

Abstract

One hundred nine runners were treated conservatively without immobilization for overuse injury to the Achilles tendon. Treatment strategies were directed toward rehabilitation of the gastrocnemius/soleus muscle-tendon unit, control of inflammation and pain, and control of biomechanical parameters. One fair, 12 good, and 73 excellent results were reported, with a mean recovery time of 5 weeks. Followup was incomplete in 23 cases. The three most prevalent etiological factors were overtraining (82 cases), functional overpronation (61 cases), and gastrocnemius/soleus insufficiency (41 cases). The authors speculate that runners are susceptible to Achilles tendinitis with peritendinitis due to microtrauma produced by the eccentric loading of fatigued muscle, excess pronation producing whipping action of the Achilles tendon, and/or vascular blanching of the Achilles tendon produced by conflicting internal and external rotatory forces imparted to the tibia by simultaneous pronation and knee extension. Virtually all cases of Achilles tendon injury appear to result from structural or dynamic disturbances in normal lower leg mechanics and require active treatment regimens which attempt to establish normal function to prevent recurrence.

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

“…Several studies report that the incidence of Achilles tendinopathy in runners accounts for 6-18% of all injuries (James et al, 1978, Clement et al, 1984, Lysholm and Wiklander, 1987, Soma and Mandelbaum, 1994, Józsa and Kannus, 1997. The highest incidence is usually reported to occur in middleaged individuals, but the exact age to which age this refers is usually not documented (Kvist, 1994, Paavola et al, 2000a, Silbernagel et al, 2001, Paavola et al, 2002a, Alfredson, 2003c.…”

“…The various predisposing risk factors related to Achilles tendinopathy that are suggested as being important in the literature are listed in Table 2 (Clement et al, 1984, Lysholm and Wiklander, 1987, Hess et al, 1989, Kvist, 1991, Haglund-Åkerlind and Eriksson, 1993, Kvist, 1994, DeMaio et al, 1995, Kannus, 1997a, Alfredson et al, 1998a, Kaufman et al, 1999, McCrory et al, 1999, van der Linden et al, 1999, Järvinen et al, 2001, Kader et al, 2002, Paavola et al, 2002a, Khaliq and Zhanel, 2003, Järvinen et al, 2005, Mahieu et al, 2005, Alfredson and Öhberg, 2005c. …”

“…Predisposing extrinsic factors are thought to be training errors, changes in training surface and ineffective or improper footwear, as well as the sideeffects of drug treatment such as fluoroquinolones (Clement et al, 1984, Hess et al, 1989, Nichols, 1989, Galloway et al, 1992, Kvist, 1994, DeMaio et al, 1995, Kannus, 1997a, van der Linden et al, 1999, Järvinen et al, 2001, Kader et al, 2002, Paavola et al, 2002a, Khaliq and Zhanel, 2003, Järvinen et al, 2005. The excessive loading of the Achilles tendon and training errors such as increasing intensity and duration too quickly are reported to be present in 60-80% of patients with Achilles tendinopathy (Kvist, 1991, Kvist, 1994, Järvinen et al, 2001, Järvinen et al, 2005.…”

“…There are various techniques for evaluating the subtalar varus and forefoot varus as measures of varus alignments that would cause functional hyperpronation during walking and running. Clinically, measurements are often made in non-weight bearing with a goniometer or in weight-bearing describing the foot as cavus, neutral or pronated (James et al, 1978, Clement et al, 1984, Kvist, 1991, Kaufman et al, 1999. A clinical classification of a high, normal and low arch can also be performed, but this is mostly a subjective measure by the evaluator with possible clinical benefits regarding decision-making if there is a need for custom-made orthotics.…”

“…Instead, many studies use patient-reported pain (on a Visual Analog Scale) with tendon loading activity as a main outcome measure to determine the success of treatment. Sometimes, it is the investigator that grades the success of treatment based on patient-reported improvements (Clement et al, 1984, Lowdon et al, 1984, Nelen et al, 1989, Leach et al, 1992, Niesen-Vertommen et al, 1992, Schepsis et al, 1994, Alfredson et al, 1998b, Angermann and Hovgaard, 1999, Paavola et al, 2000b, Mafi et al, 2001, Testa et al, 2002, Öhberg and Alfredson, 2002, Alfredson and Lorentzon, 2003a, Gill et al, 2004, Koenig et al, 2004, Paoloni et al, 2004, Öhberg et al, 2004b, Costa et al, 2005, Alfredson and Öhberg, 2005d.…”