Achilles Tendonitis & Achilles Tendinopathy / Tendonoses

Achilles Tendonitis & Achilles Tendinopathy

One of the challenges we face when someone presents to us with Achilles heel pain problems is they received treatment for Achilles Tendonitis when they have Tendonoses or Achilles Tendinopathy.

First, the correct diagnoses needs to be made.  Second, the cause needs to be found.  Third, the correct treatment needs to be prescribed.

Achilles Tendon Inflammation vs. Degeneration

The term Achilles tendonitis should be used to refer to inflammation of the Achilles tendon. Inflammation is most often an acute change (the result of a sudden injury). This problem is characterized by swelling, redness, warmth, and pain. When seen under the microscope, inflammatory conditions have specific cells that the body brings to that area of the body to help control the inflammation and heal the injured tendon.  We have seen patient receive massage (additional trauma), shockwave therapy (sever trauma) and stretches (more trauma).  These are all incorrect treatments for Achilles Tendonitis.

Achilles Tendinosis or Achilles Tendinopathy is a very different condition that is not characterised by inflammation. Rather, these patients have thickening of the tendon. There is usually no redness or warmth of the surrounding tissue, although the area can be painful to touch. Achilles tendinosis is a chronic problem, meaning it develops gradually and lasts a long time. When seen under a microscope, inflammatory cells are not present, although chronic damage and microscopic tears of the tendon may be seen.  We have seen people come to use who have been prescribed anti-inflammatory drugs which are not going to work when there is no inflammation or have been told to ice it, but it not an acute injury and does not require ice.

We have a good understanding of the fundamental differences, are capable of diagnosing the condition and conduct a thorough bio-mechanical assessment to find out why it occurred in the first place. Then, and only then, can we recommend a successful treatment.