Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments

Abstract

Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors. Failed healing response and degenerative changes were found in the tendon. The failed healing response includes three different and continuous stages (reactive tendinopathy, tendon disrepair, and degenerative tendinopathy). The histological studies have demonstrated an increased number of tenocytes and concentration of glycosaminoglycans in the ground substance, disorganization and fragmentation of the collagen, and neovascularization. There are variable conservative and surgical treatment options for Achilles tendinopathy. However, there has not been a gold standard of these treatments because of the controversial clinical results between various studies. In the future, new level I researches will be needed to prove the effect of these treatment options.

Achillodynie u rekreačních běžců

“…Při správném provádění se zvyšuje aktivita fi broblastů, zrychluje se tvorba kolagenních vláken a zvětšuje jejich tloušťka, následkem je větší síla, pevnost a hypertrofi e šlachy (LaSta yo et al, 2003). Excentrický trénink snižuje neovaskularizace, což eliminuje bolest a negativní příznaky tendopatie (Li & Hua, 2016). Stasin opoulos a Manias (2013) ve své studii vyhodnotili jako nejefektivnější 12týdenní program dle Alfredsona kombinovaný se statickým strečinkem dle Stanishe.…”

Lateral versus central tendon-splitting approach to insertional Achilles tendinopathy: a retrospective study

“…(3) Although the exact pathogenesis of IAT remains unknown, increased mechanical strain, advancing age and decreased vascularity are often deemed as causative factors. (4)(5)(6) Clinical presentations include localised pain over the posterior heel, swelling, burning and stiffness, which usually are aggravated by exertion. (7) Radiology may show calcifications at the insertion of the Achilles tendon, with oedema and thickening of the insertional area of the tendon that may be seen on magnetic resonance imaging.…”

“…Surgery typically includes partial or total detachment of the Achilles tendon, excision of retrocalcaneal bursa, resection of prominent superior calcaneal tuberosity, debridement of the diseased tendon and reattachment of the tendon. (6,12) A tendon transfer may be considered. (4,13) The surgery can be done either by open or endoscopic means.…”

Successful Treatment of Achilles Tendinopathy with Electroacupuncture: Two Cases

“…A chilles tendinopathy is a common occurrence, with an estimated incidence of 5.6% in the general population and up to 9% in active runners. 1 Achilles tendinopathy can be divided into two main categories: (1) midsubstance (area superior to the myotendinous junction) versus (2) insertional (myotendinous junction to the insertion on the calcaneus). Therapeutic interventions are guided by the type of tendinopathy.…”