Achilles tendon lesions

Achilles tendon disorders

The Achilles tendon is the largest and the strongest tendon in the body. It is formed from the coalescence of the tendons of the gastrocnemius and soleus muscles and is inserted into the calcaneal tuberosity of the os calcis.

• the tendon is more prone to injury due to its limited blood supply
• majority of injuries are caused by gradual wear and tear from overuse or aging
• disorders of the tendon is often seen in people with an active lifestyle (e.g. - competitive and recreational athletes alike) as well as sedentary people (1,2,3)

Inconsistent and erroneous change in nomenclature of disorders of the Achilles tendon throughout the years has resulted in a large pool of confusing definitions and terms.

• tendinitis (tendonitis) has been used traditionally to describe overuse injury to the tendon that is chronic in nature (3) However studies have reported little or no inflammation within the injured tendon, hence the term tendinosis was proposed (2)
  • researchers have later clarified the difference between these two terms
    • Achilles tendinitis (tendonitis) - there is a clinical presence of pain and swelling with an inflammatory process present on a biopsy specimen of a diseased tendon
    • Achilles tendinosis - a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation (4)
• in 1998, Maffulli et al suggested the term tendinopathy in order to describe the clinical syndrome characterized by a combination of pain, swelling and impaired performance (2)

Note:

• it has been suggested that tendinopathy or tendinosis are more accurate terms, with tendinopathy the clinical term and tendinosis its pathological equivalent (1).

Reference:

• (1) Asplund CA, Best TM. Achilles tendon disorders. BMJ. 2013;346:f1262.
• (2) van Dijk CN et al. Terminology for Achilles tendon related disorders. Knee Surg Sports Traumatol Arthrosc. 2011;19(5):835-41.
• (3) Papa JA. Conservative management of Achilles Tendinopathy: a case report. J Can Chiropr Assoc. 2012;56(3):216-24.
• (4) Lopez RG, Jung HG. Achilles tendinosis: treatment options. Clin Orthop Surg. 2015;7(1):1-7.