Bringing Achilles tendinopathy to heel
Mark Barry LPN, PMAC, LPRT

October 2010 
Volume 40  Number 10
Pages 30 - 33
  PDF Version Available!

ONE OF THE MOST COMMON injuries seen today in both general and sports medicine practices, Achilles tendon-related injuries (tendinopathy) are on the increase. This is largely related to renewed interest in fitness, especially sports involving high velocity or abrupt velocity changes, such as basketball, football, soccer, running, and racquet sports. This article describes how injuries occur and discusses assessment and interventions for a patient with Achilles tendinopathy. But first, a word about the terminology.The term Achilles tendinitis was once widely used to describe any pain involving the back of the heel. But research has shown that evidence of prostaglandin-mediated inflammation is rarely present. The term tendinopathy is now preferred to describe Achilles tendon injury or degradation without clinical or histologic signs of inflammation.1–3The largest tendon in the body, the Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus). It allows us to run, jump, and stand on our toes. Although very strong, it has a poor blood supply and is susceptible to injury from overuse.4,5 The following case history is a typical example.Dan Miller, 40, is a middle-distance runner who reports to your clinic with pain and tenderness along his left Achilles tendon. He states that his pain has been present for approximately 2 weeks, is usually worse when he arises from bed, and continues when he runs. He says he's tried taking ibuprofen for the pain but it's not very effective.When you question him about recent activity, Mr. Miller reports that because he's in training for a 26-mile marathon, he's increased his running mileage from 30 to 40 miles/week. He's run several middle-distance events (3 to 7 miles) with no problems in the past. He denies any injuries or changes in footwear that might explain his current symptoms.Mr. Miller's medical history is unremarkable for cardiopulmonary disease, hypertension,

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