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's 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 microtraumas from unusual or excessive mechanical loading are deemed to be a causative factor.


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


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 presents, it usually indicative of poorer outcome and more severe clinical symptoms. Additional signs include increased Kager's fat pad echogenicity and increase thickening of hypoechoic paratendon. 


Can show increased intratendinous signal and tendon enlargement +/- oedema in Kager's fat pad anterior to the Achilles tendon (in cases of tendinosis).

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Article Information

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

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