Achilles tendinopathy

Achilles tendinopathy refers to a combination of pathological changes affecting the Achilles tendon usually due to overuse and excessive chronic stress upon the tendon. It can be seen both in athletes and non-athletes (weekend warriors). It is hard to differentiate clinically from a paratendinopathy (which is most common). It may or may not be associated with an Achilles tendon tear

It can affect a range of people from athletes to recreational exercisers and even inactive people.

Macroscopically, tendinopathy results in enlargement, disruption of fibrillar pattern and an increase in tendon vascularity. Histopathologically, there is evidence of disorganised proliferation of tenocytes, disrupted organisation of collagen fibres, and an increase in the noncollagenous matrix, and neovascularization. Usually, there is no evidence of inflammation, but the cause is thought of as a failed healing response 1. Repetitive microtrauma from unusual or excessive mechanical loading is deemed to be a causative factor.

Location

It particularly affects the mid and distal portions of the tendon 2.

Ultrasound

Often shows thickening and rounding of the affected portion of the tendon. The cutoff value of 1 cm in anteroposterior diameter is usually used for diagnosis. There is also evidence of neovascularisation, which, if present, is usually indicative of a poorer outcome and more severe clinical symptoms. Additional signs include increased Kager's fat pad echogenicity and thickening of a hypoechoic paratenon.

MRI 

Can show increased intratendinous signal and tendon enlargement, with oedema in Kager's fat pad in cases of tendinosis.

Share article

Article information

rID: 40410
Tag: ankle
Synonyms or Alternate Spellings:
  • Achilles tendinosis
  • Achilles tendonitis
  • Achilles tendinitis

Support Radiopaedia and see fewer ads

Cases and figures

  • Drag
    Case 1: with tear
    Drag here to reorder.
  • Drag
    <br />
    Case 2
    Drag here to reorder.
  • Drag
    Case 3
    Drag here to reorder.
  • Updating… Please wait.
    Loadinganimation

    Alert accept

    Error Unable to process the form. Check for errors and try again.

    Alert accept Thank you for updating your details.