A 36 yo man had a 3 month duration of left ankle pain. He had pain at the left heel extending into the left calf following his 2 mile walking routine. He went to a physician and and was diagnosed with Achilles tendinopathy and prescribed rest for 2 weeks with NSAIDs. He was started on physical therapy.In a healthy adult, the tendon appears white and smooth. The tendon is supplied with blood mainly in 3 zones: the muscle tendon junction, the length of the tendon, and the tendon bone junction.

In adults, the muscle tendon junction is the best supplied and the tendon bone junction is the least well supplied.Achilles tendinopathy is an overuse injury wherein chronic stresses on the tendon, have resulted in neovascularization and disorganization of the Type I collagen. A pathologic tendon typically appears brownish, uneven, and thick. Most likely these changes occur because of disrupted, long-term, and abnormal healing processes following frequent strains of the tendon leading to remodeling and formation of scar tissue. Observing for atrophy, swelling, and range of motion tests can help determine anatomic deformities and limitations.

To differentiate between an injury to the tendon and an injury to the fascia, a positive Arc sign, wherein swelling moves with dorsiflexion of the foot, can be performed. Achilles rupture should also be ruled out by performing a Thompson test. An acute injury can prompt ultrasound or MRI imaging to rule out partial tears. Recovery can take 3-6 months. Identification of aberrant biomechanics such as leg-length discrepancy and gait cycle contributions can be corrected with orthotics and exercise routines respectively.

Corticosteroid shots are not recommended as adverse effects include tendon atrophy, rupture, and vasoconstriction. Platelet rich plasma injections have also been explored as they are used to accelerate healing. While PRP has been shown to improve symptoms and ability to perform physical activities, larger sized randomized control studies are still pending.

Li HY et al. Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Res Int. 201