Everything Achilles: Knowledge Update and Current Concepts in Management

Abstract

Achilles tendon pathology is common and affects athletes and nonathletes alike. The cause is multifactorial and controversial, involving biological, anatomical, and mechanical factors. A variety of conditions characterized by Achilles tendon inflammation and/or degeneration can be clinically and histologically differentiated. These include insertional Achilles tendinopathy, retrocalcaneal bursitis, Achilles paratenonitis, Achilles tendinosis, and Achilles paratenonitis with tendinosis. The mainstay of treatment for all of these diagnoses is nonoperative. There is a large body of evidence addressing treatment of acute and chronic Achilles tendon ruptures; however, controversy remains.

Quantitative Ultrasound Assessment of the Achilles Tendon Under Varied Loads

“…With accurate quantification of Achilles tendon strength in vivo, the tendons that are weakest, and thus at greatest risk of rupture, could potentially be identified. Once an Achilles tendon tear has occurred, the choice between surgical and nonsurgical management can be controversial . Thus, the ability to differentiate tendons that are healing successfully from those that are not is clinically important.…”

“…Achilles tendinopathy is a common degenerative process, which is disproportionately seen as a sports‐related injury affecting men in their third and fourth decades . Although tendinosis affects 34% of Achilles tendons at autopsy, rupture is relatively rare, with an annual incidence of 18 per 100,000 .…”

“…Achilles tendinopathy is a common degenerative process, which is disproportionately seen as a sports‐related injury affecting men in their third and fourth decades . Although tendinosis affects 34% of Achilles tendons at autopsy, rupture is relatively rare, with an annual incidence of 18 per 100,000 . Tendinopathy is characterized by loss of tendon collagen and fiber disorientation on histologic analysis and is depicted on grayscale ultrasound (US) images as tendon thickening, heterogeneity, and hypoechogenicity .…”

Treatment of hindfoot and ankle pathologies with posterior arthroscopic techniques

“…34 The ‘two-finger’ squeeze test, squeezing the thickened bursa in a mediolateral direction, often elicits pain in patients with retrocalcaneal bursitis. 37 …”

Treatment of Achilles tendinopathy: state of the art

“…In 1992, based on differential anatomical localisations and clinical pictures, AT was split into insertional AT  and non-insertional -AT (NIAT) 4. The difficulties in treating AT often relate to the combination of deficient diagnostics, lack of understanding underlying aetiological factors, poor staging of the disease and few therapies targeted to the primary pathology.…”