Insertional Achilles tendinopathy
CONSULT TREATMENT PROTOCOL

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GLOSSARY OF DISEASES

NameTissueType of pathologies
Acute and chronic muscle aches and pain Muscle Pain management
Acute and chronic cervical and lumbar pain Muscle Idiopathic cervical and low back pain
Acute and chronic soft tissue wounds Skin Wounds
Adhesive capsulitis Joint Capsulitis
Calcifying tendinitis of the shoulder Tendons Tendinopathy
Cellulite Skin Cellulite
Chronic distal biceps tendinopathy Tendons Tendinopathy
Chronic proximal hamstring tendinopathy Tendons Tendinopathy
Diseases secondary to trigger points and myofascial Pain Muscle Myofascial pain syndrome
Golfer’s elbow Tendons Tendinopathy
Greater trochanteric pain syndrome Tendons Tendinopathy
Insertional Achilles tendinopathy Tendons Tendinopathy
Knee osteoarthritis Joint Osteoarthritis
Medial tibial stress syndrome Tendons Tendinopathy
Mid-body Achilles tendinopathy Tendons Tendinopathy
Osgood-Schlatter disease Bone Disturbance of musculoskeletal development
Patella tip syndrome Tendons Tendinopathy
Plantar fasciopathy Tendons Tendinopathy
Primary and secondary lymphedema Skin Lymphedema
Primary long bicipital tenosynovitis Tendons Tendinitis
Proliferative connective tissue disorders Connective tissue Fibrosis
Spasticity Central nervous system Cerebral palsy and stroke
Stress fractures Bone Fracture
Subacromial pain syndrome Tendons Tendinopathy
Superficial nonunions Bone Fracture
Tennis elbow Tendons Tendinopathy
Trigger points Muscle Myofascial pain syndrome
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MORE INFORMATION

Insertional Achilles tendinopathy (with or without Haglund’s deformity)
The Achilles tendon is the combination of tendons of the soleus and gastrocnemius muscles and connects these muscles to the back of the heel. Insertional Achilles tendinopathy (IAT) – with or without Haglund’s deformity – is an acute or chronic painful disorder of the Achilles tendon at its insertion onto the calcaneus. Several terms have been used to describe this condition including tendinosis, tendinitis and peritendinitis.

However, histologic examination of biopsy specimens from patients undergoing surgery for chronic symptoms has shown that chronic IAT is associated with degenerative changes in the tendon. Accordingly, the disease is better characterized as tendinopathy than tendinitis or tendinosis.

Diagnosis is based on the clinical features of the disease, with the location of the pain as an important discriminating factor. The spot of maximum pain in IAT is located at the tendon-bone junction, whereas in case of noninsertional Achilles tendinopathy, the spot of maximum pain is 2 to 6 cm proximal to the insertion. Symptoms can be exacerbated by running on hard surfaces and climbing stairs. Diagnostic imaging should be considered to rule out other causes of Achilles tendon pain and heel pain, or to establish the diagnosis of IAT when in doubt.

The etiology of IAT is likely multifactorial and may include advanced age, obesity, hypertension, diabetes, hyperpronation and steroid use, to mention only a few. Particularly in athletes the onset of IAT may also be influenced by poor training habits including excessive training, training on hard or sloping surfaces, and abrupt changes in scheduling.

It has been hypothesized that healing of injuries of the Achilles tendon as a result of overuse involves the penetration of small blood vessels into the tendon in order to increase healing by providing improved blood flow. However, these small blood vessels are accompanied by small nerve fibers with high concentrations of nociceptive substances including glutamate, substance P, and calcitonin gene-related peptide (CGRP). These small nerve fibers are considered the cause of pain in chronic IAT.

Runners comprise the largest group of patients with chronic pain in the Achilles tendon. The annual incidence of IAT among athletes is approximately 8%. However, individuals of all activity levels and all ages present with similar complaints.

The treatment of IAT should start with conservative treatment modalities including rest, icing, physiotherapy, stretching (eccentric loading), exercises, orthoses, heel lifts and non-steroidal anti-inflammatory drugs. In certain cases braces and immobilization with a cast or a pneumatic walking boot may improve the situation. Patients not responding to conservative treatment for six months shall then be subjected to radial shock wave therapy (RSWT). Surgery should be considered for recalcitrant cases of IAS, with different surgical strategies described in the literature. Prevention of recurrence should focus on appropriate exercise habits, wearing low-heeled shoes and eccentric strengthening exercises.

 

CLINICAL EVIDENCE

Rompe et al., Am J Bone Joint Surg 2008;90:52-61

Eccentric loading compared with shock wave treatment for chronic insertional achilles tendinopathy. A randomized, controlled trial.

READ ABSTRACT

TREATMENT PROTOCOL

STANDARD TREATMENT MYOFASCIAL THERAPY
Number of treatment sessions 3 to 5 3 to 5
Interval between two sessions 1 week 1 week
Air pressure Evo Blue® 2 to 4 bar 3 to 4 bar
Air pressure Power+ 1.5 to 3 bar 2 to 4 bar
Impulses 2000 on the painful spot 2000
Frequency 8Hz to 12Hz 12Hz to 20Hz
Applicator 15mm 36mm
Skin pressure Moderate 3 sides of the tendon Moderate to high

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