The Practical Management of Achilles Tendinopathy

Sorosky, Brad; Press, Joel M.; Plastaras, Christopher T.; Rittenberg, Joshua D.

doi:10.1097/00042752-200401000-00007

Cited by 37 publications

(19 citation statements)

References 26 publications

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“…Maffulli et al’s publication has greatly helped to reduce the confusion in clinical terminology; the proposal was broadly accepted, but it was not, however, implemented universally. Terminology has therefore remained confusing [27, 40]. …”

Section: Historical Perspectivementioning

confidence: 99%

Terminology for Achilles tendon related disorders

Dijk

Sterkenburg

Wiegerinck

et al. 2011

Knee Surg Sports Traumatol Arthrosc

321

209

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The terminology of Achilles tendon pathology has become inconsistent and confusing throughout the years. For proper research, assessment and treatment, a uniform and clear terminology is necessary. A new terminology is proposed; the definitions hereof encompass the anatomic location, symptoms, clinical findings and histopathology. It comprises the following definitions: Mid-portion Achilles tendinopathy: a clinical syndrome characterized by a combination of pain, swelling and impaired performance. It includes, but is not limited to, the histopathological diagnosis of tendinosis. Achilles paratendinopathy: an acute or chronic inflammation and/or degeneration of the thin membrane around the Achilles tendon. There are clear distinctions between acute paratendinopathy and chronic paratendinopathy, both in symptoms as in histopathology. Insertional Achilles tendinopathy: located at the insertion of the Achilles tendon onto the calcaneus, bone spurs and calcifications in the tendon proper at the insertion site may exist. Retrocalcaneal bursitis: an inflammation of the bursa in the recess between the anterior inferior side of the Achilles tendon and the posterosuperior aspect of the calcaneus (retrocalcaneal recess). Superficial calcaneal bursitis: inflammation of the bursa located between a calcaneal prominence or the Achilles tendon and the skin. Finally, it is suggested that previous terms as Haglund’s disease; Haglund’s syndrome; Haglund’s deformity; pump bump (calcaneus altus; high prow heels; knobbly heels; cucumber heel), are no longer used.

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Section: Historical Perspectivementioning

confidence: 99%

Terminology for Achilles tendon related disorders

Dijk

Sterkenburg

Wiegerinck

et al. 2011

Knee Surg Sports Traumatol Arthrosc

321

209

View full text Add to dashboard Cite

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“…Localized swelling between the paratenon and Achilles can be visualized and palpated. 124 More commonly, however, symptoms are chronic in nature and are associated with a degenerated tendon. 48 Tendinosis is thought to be noninflammatory, 10,53 though this remains an active area of exploration.…”

Section: Pathoanatomical Featuresmentioning

confidence: 99%

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

Carcia

Martin²,

Houck³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

119

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The Orthopaedic Section of the American Physical Therapy Association presents this sixth set of clinical practice guidelines on Achilles pain, stiffness, and muscle power deficits that are characteristic of Achilles Tendinitis. These clinical practice guidelines are linked to the International Classification of Functioning, Disability, and Health (ICF). The purpose of these practice guidelines is to describe evidence-based orthopaedic physical therapy clinical practice and provide recommendations for (1) examination and diagnostic classification based on body functions and body structures, activity limitations, and participation restrictions, (2) interventions provided by physical therapists, (3) and assessment of outcome for common musculoskeletal disorders. J Orthop Sports Phys Ther 2010:40(9):A1–A26. doi:10.2519/jospt.2010.0305

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“…Leadbetter and Khan et al have suggested that "tendinosis" are degenerative changes resulting from increased demand on tendons with inadequate repair and progressive cell death [139,140]. This model explained the generation of overuse injury, and the reasons for inadequate repair are attributed to adaptive response to tissue overload as elaborated by Kibler and Sorosky et al [141,142]. However, "inadequate repair" as quantitative decrease in healing cells cannot explain the findings of focal hypercellularity, active proliferation and metaplasia in tendinopathy samples.…”

Section: Previous Theories Of Pathogenesis Of Tendinopathymentioning

confidence: 99%

Deciphering the pathogenesis of tendinopathy: a three-stages process

Rolf

Cheuk

et al. 2010

BMC Sports Sci Med Rehabil

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Our understanding of the pathogenesis of "tendinopathy" is based on fragmented evidences like pieces of a jigsaw puzzle. We propose a "failed healing theory" to knit these fragments together, which can explain previous observations. We also propose that albeit "overuse injury" and other insidious "micro trauma" may well be primary triggers of the process, "tendinopathy" is not an "overuse injury" per se. The typical clinical, histological and biochemical presentation relates to a localized chronic pain condition which may lead to tendon rupture, the latter attributed to mechanical weakness. Characterization of pathological "tendinotic" tissues revealed coexistence of collagenolytic injuries and an active healing process, focal hypervascularity and tissue metaplasia. These observations suggest a failed healing process as response to a triggering injury. The pathogenesis of tendinopathy can be described as a three stage process: injury, failed healing and clinical presentation. It is likely that some of these "initial injuries" heal well and we speculate that predisposing intrinsic or extrinsic factors may be involved. The injury stage involves a progressive collagenolytic tendon injury. The failed healing stage mainly refers to prolonged activation and failed resolution of the normal healing process. Finally, the matrix disturbances, increased focal vascularity and abnormal cytokine profiles contribute to the clinical presentations of chronic tendon pain or rupture. With this integrative pathogenesis theory, we can relate the known manifestations of tendinopathy and point to the "missing links". This model may guide future research on tendinopathy, until we could ultimately decipher the complete pathogenesis process and provide better treatments.

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The Practical Management of Achilles Tendinopathy

Cited by 37 publications

References 26 publications

Terminology for Achilles tendon related disorders

Terminology for Achilles tendon related disorders

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

Deciphering the pathogenesis of tendinopathy: a three-stages process

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