Achilles Tendinopathy Pathogenesis and Management: A Narrative Review (original) (raw)
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An Overview of Achilles Tendinopathy Management
Osteology, 2021
Background: Persistent tendon pain and swelling related to mechanical loading are the main signs of Achilles tendinopathy (AT). This condition is one of the most common tendinopathies of the lower limb affecting mainly athletes involved in running and jumping sports. Methods: we included pivotal papers retrieved from the literature (Pubmed, Google Scholar, PEDro, and Scopus) to present an overview of the management of AT, with a specific focus on conservative management. Results: An accurate and timely diagnosis of AT is necessary to set up early treatments and to manage the problem conservatively. Diagnosis is primarily based on clinical assessment; instrumental imaging may be helpful in confirming the clinical diagnosis. Conservative treatment is effective in most cases, mainly using physical exercise based on eccentric training. Other non-surgical treatments such as extracorporeal shock wave therapy, thermotherapies, and injections can be added to exercise. Surgical treatment is ...
The Lower Limb Tendinopathies, 2016
Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, and lateral ankle instability are considered common risk factors. Currently, intratendinous degenerative changes are considered responsible for tendinopathy and symptoms. Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientifi c research to clarify the optimal management option. The management of Achilles tendinopathy lacks evidence-based support, and patients are at risk of long-term morbidity with unpredictable clinical outcome. Most patients respond to conservative management. Eccentric exercises and shockwave provide excellent clinical results both in athletic and sedentary patients, with no reported adverse effects. However, in about 20-45 % of cases, patients do not respond well to conservative treatment, and they need surgery. Both minimally invasive and open surgeries have been described with similar results.
Applied Sciences
Achilles tendinopathy (AT) is the most common injury of the Achilles tendon and represents 55–65% of all Achilles tendon clinical diagnoses. AT is characterized by pain, swelling, and impaired performance. ATs can be divided into two types, according to anatomical location—midportion AT (MAT) and insertional AT (IAT). MAT more often occurs in older, less active, and overweight populations, while IAT usually occurs in the more physically active population. Both types of AT can be treated by different treatments, such as surgery, conservative pharmacological treatments, and conservative nonpharmacological treatments. This umbrella review aims to assemble the evidence from all available systematic reviews and/or meta-analyses to determine which conservative nonpharmacological treatments are most commonly used and have the greatest effects. Three major electronic scientific databases (PubMed, Scopus, and Web of Science) were screened. The reference lists of several recent articles on AT...
Achilles Tendinopathy and Associated Disorders
Foot & Ankle Orthopaedics
Degenerative disorders of the Achilles tendon are common, affecting up to 18% of the adult population. A thorough evaluation including a focused history, physical examination, and diagnostic studies helps in choosing the appropriate treatment. Initial treatment is usually nonoperative, consisting of activity modification, bracing, and physical therapy. Patents who fail nonoperative management may be treated operatively with a wide range of procedures from endoscopic surgery to open debridement and tendon transfer. Understanding a patient's expectations and educating patients about potential treatments and their outcomes enables informed collaborative decision making. This article will review the evaluation and management Achilles tendinopathy and associated disorders.
Tendinopathy of the Main Body of the Achilles Tendon
Foot and Ankle Clinics, 2005
Achilles tendon disorders are common in athletes and within the general population . Within the spectrum of Achilles tendon disorders, many different pathologic conditions exist. These conditions may coexist or may occur in isolation; the descriptive terminology used to describe the specific disorders of the Achilles tendon may be confusing and inaccurate. This article reviews chronic tendinopathy of the main body of the Achilles tendon [2], a condition with a combination of tendon pain, swelling, and impaired performance ability. Chronic tendinopathy has been described arbitrarily as the above condition with symptoms that last longer than 6 weeks . The etiology, pathogenesis, anatomy, epidemiology, and natural history of chronic Achilles tendinopathy largely is unknown. Overuse injuries, poor vascularity, genetic makeup, gender, and endocrine or metabolic factors have been cited as possible etiologic factors .
Update in Management of Foot and Ankle Disorders, 2018
Achilles tendon (AT) is the strongest human tendon. AT disorders are common among athletes. AT pathologies vary from tendinopathy to frank rupture. Diagnosis is made clinically. Imaging modalities are used adjunctively. Management of AT rupture in athletes is challenging to surgeons due to worldwide growing popularity of sports and potential social and financial impact of AT injury to an athlete. Hence, new surgical techniques aim at attaining quick recovery with good outcome, finding similar results with both open and percutaneous techniques when accompanying these with functional rehabilitation protocols. Non-operative strategies include shoe wear modification, physiotherapy and extracorporeal shock wave therapy. Surgical interventions vary based on the AT pathology nature and extent. Direct repair can work for small-sized defects. V-Y gastrocnemius advancement could approximate the tendon edges for repair within 2-8 cm original gap. Gastrocnemius turndown can bridge tendon loss > 8 cm. Autogenous, allogeneous or synthetic tendon grafts were used for AT reconstruction purposes. In AT tendinopathies with no tendon tissue loss, surgical procedures revolve around induction of tissue repair through lesion incision or debridement to full detachment followed by reattachment. Extra-precautions are exercised for prevention of AT disorders especially among susceptible athletes participating in sports involving excessive AT strain.