Achilles tendinopathy

Dr Henry Knipe and Dr Yuranga Weerakkody et al.

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. 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. It affects non-athletes in around one-third of cases. 

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 organization of collagen fibers, 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.

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 neovascularization, 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.

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

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Article information

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

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Cases and figures

  • Case 1: with tear
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    Case 2
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  • Case 3
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