WHAT IS IT?
Achilles Tendinosis is damage to the Achilles tendon that results in degenerative changes without inflammation. Insertional Achilles tendinosis refers to isolated pain at the heel where the Achilles tendon is attached, whereas a non-insertional Achilles tendinosis refers to pain occurring in the main body of the Achilles tendon.
The Achilles tendon is the largest and strongest tendon in the human body. This tendon connects two muscles responsible for ankle plantarflexion to the heel bone. This movement provides the elasticity and shock-absorbance of the foot in walking, running, and jumping. Between the tendon and the heel is a small sac of fluid (bursae) to cushion the tendon.
Despite the strength of the tendon, it is highly susceptible to injury due to its limited blood supply and the high tensions placed on it. With chronic overuse of the tendon, microtears in the tendon can develop overtime. Without enough time to heal and rest from the repetitive strains, it can result in the breakdown of collagen, growth of abnormal blood vessels, and thickening of the tendon sheath.
Other potential causes of Achilles tendinosis include decreased blood supply, decreased tensile strength with aging, muscle imbalance or weakness, insufficient flexibility, and malalignment such as hyperpronation of the foot.
Tendon injuries occur in 30%-50% of all sports
related injuries. 66% of joggers complain of Achilles tendon pain and 23% of them usually have insertional Achilles tendinosis.
Risk Factors and Prognosis
Risk factors for the development of Achilles tendinosis include diabetes, hypertension, obesity, hormone replacement, use of oral contraceptives, and a high arch foot (pes cavus).
If tendinosis is recognized at an early stage, the duration of treatment can be as brief as 6–10 weeks. However, once the tendinosis has become chronic, treatment may be required for 3–6 months. One study reported that effective treatment might take up to 9 months in chronic tendinosis. Additionally, it is reported that tendons “require over 100 days to make new collagen.” As such, treating chronic tendinosis for a few weeks would provide little long-term benefit for tendon repair.
There are various treatment options available to treat this condition.
Eccentric training promotes tendon healing by loading the tendon in a lengthened position, increasing the tendon’s capacity to bear weight overtime. It may also damage the abnormal blood vessels and nerves, and eliminate the pain associated with it. Massage/soft tissue release, hot and cold compresses, and ultrasound therapy have demonstrated to be beneficial. The use of extracorporeal shockwave therapy has been controversial for achilles tendinosis, but its basis of use is that it produces microtrauma to promote tissue healing and relief from pain.
To reduce the load on the tendon as it is healing, activity modification, custom orthotics, and heel lifts should be encouraged in conjunction with physiotherapy treatments.
Custom orthotics help by accommodations that help shorten the achilles tendon and accommodate a high or low arch. This reduces excessive strain on the tendon specially in walking and running allowing it to heal properly.
Other Non-Invasive Treatments
Cortisone injection (steroid injection) is ineffective as the condition does not involve inflammation per se. Other medications that have been used for tendinosis include aprotinin and sclerosing agents. Prolotherapy (a type of injection to help repair the tendon) has shown promise.
Surgical interventions should be considered in severe cases of Achilles tendinosis or when conservative treatments have been exhausted.
References Advances Health. Achilles Tendon problems. [Digital image.] Retrieved from: http://advancedhealth.ca/clients/516/images/Achilles-Tendon-Problems.jpg
Bass, E. (2012.) Tendinopathy: Why the difference between tendinitis and tendinosis matters. Int J Ther Massage Bodywork, 5(1): 14- 17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312643/ Lopez, R.G.L., & Jung, H. G. (2015.) Achilles tendinosis: Treatment options. Clin Orthop Surg, 7 (1):1-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329521/ Maurer, S. (2014.) Tendinitis and tendinosis. Retrieved from: http://www.innerbody.com/diseases-conditions/tendinitis-and-tendinosis Physiopedia (2015.) Achilles tendon. Retrieved from: https://www.physio-pedia.com/Achilles_tendon BodyHeal.com.au Achilles Tendon Injuries: [Digital image.] Retrieved from: http://www.bodyheal.com.au/image/catalog/achilles-tendon-tendinosis.jpg Dynamic Chiropractic: [Digitial image.] Retrieved from: http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=9269 Sports Health: [Digital image.] Retrieved from: https://www.sports-health.com/blog/when-heel-pain-caused-bone-spurs Pinterest: [Digital image.] Retrieved from: https://www.pinterest.ca/richfeetorg1/achilles-tendon-information/?lp=true