Evidence Based Treatment for Achilles Tendon Injuries

The Achilles tendon, which runs from the top of the heel to the back of the calf, is a strong, non-elastic, fibrous tissue that attaches the gastrocnemius muscle (Figure 1A) and the soleus muscle (Figure 1B) to the calcaneus (heel bone)1. Another name for the muscle group sharing the Achilles tendon is the “triceps surae.” The Achilles tendon can effectively absorb ground reactive forces associated with running that can approach 6-8 times body weight with an average of 800 foot strikes per mile.2,23 Injury to the Achilles tendon or its surrounding sheath, the paratendon, can be the result of overuse, improper training, gait abnormalities, age-related degenerative changes, or improper footwear.1-7 Recreational runners who prematurely increase the intensity, duration, and/or frequency of their training sessions are prone to developing Achilles tendon injuries because the Achilles tendon does not have the time to adapt to the increased demand. Improper training may lead to microtears and degenerative changes to the Achilles tendon or the surrounding paratendon,weakening the tendon and predisposing it to further injury. Achilles tendon injuries usually occur gradually, increasing in severity without proper treatment and rehabilitation. Symptoms of Achilles tendon injuries can include one or more of the following:
• diffuse or localized swelling and tenderness around the tendon
• pain with the first few steps after getting out of bed in the morning
• exacerbation of the injury upon walking uphill.
Conservative therapy can aid in the normal reparative processes of Achilles tendon healing, thereby allowing athletes to return to their sport more quickly.There are three classifications of Achilles tendinopathies: tendinosis, tendonitis, and paratenonitis. Achilles tendinosis is a non-inflammatory asymptomatic condition that may lead to abnormal thickening of the tendon or other structural degenerative changes. These degenerative changes compromise the strength and function of the Achilles tendon, predisposing it to further injury. Achilles tendonitis and paratenonitis are painful inflammatory conditions of the Achilles tendon and surrounding paratendon respectively.
To develop effective treatments for these injuries, it is necessary to understand the biomechanics of the ankle joint, the function of the triceps surae during a normal running gait, and the conditions that predispose the Achilles tendon to injury.

Evidence Based Treatment for Achilles Tendon Injuries

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