The Achilles tendon is the biggest and strongest tendon in the human body. The tendon has the capacity to resist large tensile forces. It stems from a distal confluence of the gastrocnemius and soleus muscle and inserts at the bottom of the calcaneus.
It can be described as
• Mid-point tendinopathy – injury at the tendon body
• Insertional tendinopathy- injury occurs at the point where tendon attaches to the calcaneal bone
1. Reactive tendinopathy – The extracellular matrix is altered with increased proteoglycan content but with little change in the collagen. This process occurs in response to i) acute overload, ii) return to loading after a rest, or iii) following a direct blow to the tendon and is reversible if appropriately managed.
2. Tendon disrepair– greater disruption of the extracellular matrix and possible vascular and neuronal ingrowth. These tendons are difficult to distinguish clinically but are more common in a young person with a chronically overloaded tendon
3. Degenerative tendinopathy– The tendon often remains hypercellular but there is little capacity for reversal of pathology due to significant (collagen) fibrillar disorganisation. Typically, these tendons are seen in active middle age people, and clinically they may have focal nodular areas in the tendon
Overloading of the Achilles tendon above the physiological limit can cause a micro-trauma. Repetitive micro-traumas that are linked with a non-uniform tension between the gastrocnemius and soleus, cause frictional forces between the fibers and abnormal concentrations of the loading in the achilles tendon. This has consequences such as the inflammation of the tendon sheath, degeneration, or a combination of both. Without the minimum time for recovery, this can lead to a tendinopathy.
Lack of arterial blood flow, local hypoxia, decreased metabolic activity nutrition could be the cause of tendon injury.
- Hyper-pronation of foot
- tight calf leading to decreased dorsiflexion
- Poor running technique like overstride and excessive dorsiflexion in midstance
- Tight hamstring may lead to tight gastro
- Lack of full knee extension
Reactive tendinopathy can get converted into tendon disrepair if tendon is not allowed to heal. If treated properly it is reversible.Degenerative tendinopathy has a poor prognosis.
Classical symptoms :
- Morning pain at the tendon
- Generally diameter of the tendon increases compare to non affected side
- Lack o taking strain on affected side
- Stiffness of the muscle on affected side\
• Plantar fasciitis• Calcaneal fracture stress• Heel pad syndrome (deep, bruises and pain in the center of the heel)• Sever’s disease• Posterior Ankle Impingement• Medial Tendinopathy• Retrocalcaneal Bursitis• Sural Nerve• Lumbar Radiculopathy• Ankle OA
• Partial Achilles Tendon Ruptured.
Achilles Tendinopathy Part 1 – Proactive Physio Knowledge
The Achilles tendon is the biggest and strongest tendon in the human body. The tendon has the capacity to resist large tensile forces. It stems from a distal confluence of the gastrocnemius and soleus muscle and inserts at the bottom of the calcaneus.
It can be described as
• Mid-point tendinopathy – injury at the tendon body
• Insertional tendinopathy- injury occurs at the point where tendon attaches to the calcaneal bone
1. Reactive tendinopathy – The extracellular matrix is altered with increased proteoglycan content but with little change in the collagen. This process occurs in response to i) acute overload, ii) return to loading after a rest, or iii) following a direct blow to the tendon and is reversible if appropriately managed.
2. Tendon disrepair– greater disruption of the extracellular matrix and possible vascular and neuronal ingrowth. These tendons are difficult to distinguish clinically but are more common in a young person with a chronically overloaded tendon
3. Degenerative tendinopathy– The tendon often remains hypercellular but there is little capacity for reversal of pathology due to significant (collagen) fibrillar disorganisation. Typically, these tendons are seen in active middle age people, and clinically they may have focal nodular areas in the tendon
Overloading of the Achilles tendon above the physiological limit can cause a micro-trauma. Repetitive micro-traumas that are linked with a non-uniform tension between the gastrocnemius and soleus, cause frictional forces between the fibers and abnormal concentrations of the loading in the achilles tendon. This has consequences such as the inflammation of the tendon sheath, degeneration, or a combination of both. Without the minimum time for recovery, this can lead to a tendinopathy.
Lack of arterial blood flow, local hypoxia, decreased metabolic activity nutrition could be the cause of tendon injury.
Reactive tendinopathy can get converted into tendon disrepair if tendon is not allowed to heal. If treated properly it is reversible.Degenerative tendinopathy has a poor prognosis.
• Plantar fasciitis• Calcaneal fracture stress• Heel pad syndrome (deep, bruises and pain in the center of the heel)• Sever’s disease• Posterior Ankle Impingement• Medial Tendinopathy• Retrocalcaneal Bursitis• Sural Nerve• Lumbar Radiculopathy• Ankle OA
• Partial Achilles Tendon Ruptured.