Etiology, Histopathology, and Outcome of Surgery in Achillodynia

Abstract

Fifty-eight patients suffering from achillodynia for a median of 12 months (range, 4-240 months) were analyzed using history, clinical findings, ultrasound findings, histopathology, and surgical outcome. Surgical criteria were daily pain or inability to perform sports activity and failure of nonoperative treatment. There were 34 men and 24 women, 31% (18 of 58 patients) of whom had no direct association with sports or vigorous physical activity. Ultrasonography was performed in all cases and showed low echogenous areas (N = 48), increased tendon diameter (N = 40), and/or peritendinous fluid (N = 11). Histopathological evaluation of tendon biopsies, obtained from regions showing pathology at surgery (N = 35), revealed altered fiber structure and arrangement, focal variations in cellularity, extracellular glycosaminoglycans, neovascularization, and/or hyalinization. In no case was inflammatory cell infiltration observed. At a median clinical follow-up of 25 months after surgery, symptoms were decreased in 86% of patients, and 76% had reached a higher activity level compared with the level before surgery. Complications occurred in 13% of operations. In conclusion, achillodynia is not always associated with excessive physical activity. Macroscopic pathologic tendons showed marked histopathologic changes, correlating well with ultrasound findings. Surgical treatment was beneficial in most cases, despite a relatively high complication rate. The etiology and reason for the lack of healing response to rest and nonoperative treatment are unclear.

Iontophoresis with or without dexamethazone in the treatment of acute Achilles tendon pain

“…Stanish and co-workers (2000) devised a system for tendon symptom classification (Table 4). To our knowledge, this classification system has not been evaluated for reliability and validity, but it has been used as an outcome measure after surgery in patients who have achillodynia (Rolf and Movin, 1997). Table 4.…”

“…Achilles tendinopathy is, however, not always related to excessive physical activity. It has been found that about one third of patients with Achilles tendinopathy do not participate in vigorous physical activity (Rolf and Movin, 1997).…”

Achilles Pain, Stiffness, and Muscle Power Deficits: Achilles Tendinitis

“…45,59 The less active are not immune as a minority of cases have been reported in sedentary groups. 43,107 Although runners appear to be the most commonly affected cohort, 59,60,62,98 Achilles disorders have been reported in a wide variety of sports. 32,33,59,60,134 It was noted that athletes are more likely to become symptomatic when training as opposed to during competitive events.…”

The Achilles Tendinopathy: Pathogenesis Review

“…It is not always associated with excessive physical activity, and in a series of 58 patients, 31% did not participate in sports or vigorous physical activity [10] . Furthermore, the use of some drugs is associated with Achilles tendinopathy and rupture [11][12][13] .…”