Curriculum · Musculoskeletal / Orthopedic / Rheumatology
Achilles tendinopathy
What it is
Pain located between the myotendinous junction and the insertion of the Achilles tendon that occurs during prolonged walking or running is typical for midsubstance Achilles tendinopathy. The mechanisms that produce the pain are complex and not fully understood, but inflammation is believed to contribute little to the process. A less common form, insertional Achilles tendinopathy, is localized to the enthesis and is typically more recalcitrant.
How it presents
The pain comes on over weeks with no injury recalled, worsens with walking or running for a moderate distance, and fails to improve with heat application or reduction of activity. It may begin as pain only with running and later become painful with walking as well. On examination the pain is localized in the Achilles tendon proximal to its insertion, or a palpable nodule is felt on the midsubstance of the tendon. There is no swelling, redness or deformity, but tenderness is elicited with moderate fingertip pressure on the tendon.