Achilles tendon enthesopathy (AE) involves four different pathologic entities of the tendon’s distal insertion to the calcaneus. These entities are described as (a) insertional Achilles tendinitis, (b) retrocalcaneal bursitis, (c) Haglund’s deformity, and
Keywords:
Achilles tendon, enthesopathy, retrocalcaneal bursitis, Haglund’s deformity, calcified tendonitisAbstract
Achilles tendon enthesopathy (AE) involves four different pathologic entities of the tendon’s distal insertion to the calcaneus. These entities are described as (a) insertional Achilles tendinitis, (b) retrocalcaneal bursitis, (c) Haglund’s deformity, and (d) intrasubstance calcification. There are many causative factors that lead to the development of AE, such as overuse, trauma, inadequate training or sport equipment, metabolic disorders and autoimmune diseases. The treatment can be initially conservative and in refractive cases surgical.
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References
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2. Karjalainen PT, Soila K, Aronen HJ, et al. MR imaging of overuse injuries of the Achilles tendon. Am J Roentgenol 2000;175(1):251–260.
3. Phisitkul P. Endoscopic surgery of the Achilles tendon. Curr Rev Musculoskelet Med 2012;5(2):156–163.
4. Saltzman C, Bonar S. Tendon problems of the foot and ankle. In: Lutter LD, Mizel MS, Pfeffer GB, eds. Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1994:236-73.
5. Lohrer H, Arentz S, Nauck T, et al. The Achilles tendon insertion is crescent-shaped: an in vitro anatomic investigation. Clin Orthop Relat Res 2008;466(9):2230–2237.
6. Knobloch K, Kraemer R, Lichtenberg A, et al. Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 2006;34(1):92–97.
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8. Klauser AS, Miyamoto H, Tamegger M, et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology 2013;267(3):837–842.
9. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of nonoperative treatment of insertional Achilles tendinosis based on MRI. Foot Ankle Int 2007;28(4):472–477.
10. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int 2012;33(6):487–491.
11. Chimenti RL, Chimenti PC, Buckley MR, et al. Utility of ultrasound for imaging osteophytes in patients with insertional Achilles tendinopathy. Arch Phys Med Rehabil 2016;97(7):1206–1209.
12. Andrew G, Jonathan S. Comparison of Achilles tendon loading between male and female recreational runners. J Hum Kinet 2014; 44:155–159.
13. Farris DJ, Buckeridge E, Trewartha G, et al. The effects of orthotic heel lifts on Achilles tendon force and strain during running. J Appl Biomech 2012;28(5):511–519.
14. Franz JR, Slane LC, Rasske K, et al. Non-uniform in vivo deformations of the human Achilles tendon during walking. Gait Posture 2015;41(1):192–197.
15. Benjamin M, Rufai A, Ralphs JR. The mechanism of formation of bony spurs (enthesophytes) in the Achilles tendon. Arthritis Rheum 2000;43(3):576–583.
16. MN van Sterkenburg, Muller B, Maas M, et al. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis. Acta Orthop 2010;81(3):387–390.
17. Fahlstrom M, Jonsson P, Lorentzon R, et al. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 2003;11(5):327–333.
18. Jonsson P, Alfredson H, Sunding K, et al. New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. Br J Sports Med 2008;42(9):746–749.
19. Rompe JD, Furia J, Maffulli N. Eccentric loading compared with shock wave treatment for chronic insertional Achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am 2008;90(1):52–61.
20. Kedia M, Williams M, Jain L, et al. The effects of conventional physical therapy and eccentric strengthening for insertional Achilles tendinopathy. Int J Sports Phys Ther 2014;9(4):488–497.
21. McCormack JR, Underwood FB, Slaven EJ, et al. Eccentric exercise versus eccentric exercise and soft tissue treatment (Astym) in the management of insertional Achilles tendinopathy: a randomized controlled trial. Sports Health 2016;8(3):230–237.
22. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med 2006;34(5):733–740.
23. Wei M, Liu Y, Li Z, et al. Comparison of clinical efficacy among endoscopy-assisted radio-frequency ablation, extracorporeal shockwaves, and eccentric exercises in treatment of insertional Achilles tendinosis. J Am Podiatr Med Assoc 2017;107(1):11–16.
24. Lee JY, Yoon K, Yi Y, et al. Long-term outcome and factors affecting prognosis of extracorporeal shockwave therapy for chronic refractory Achilles tendinopathy. Ann Rehabil Med 2017;41(1):42–50.
25. Taylor J, Dunkerley S, Silver D, et al. Extracorporeal shock-wave therapy (ESWT) for refractory Achilles tendinopathy: a prospective audit with 2-year follow up. Foot (Edinb) 2016; 26:23–29.
26. S de Jonge, RJ de Vos, Van Schie HT, et al. One-year follow-up of a randomized controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy. Br J Sports Med 2010;44(9):673–677.
27. Chimenti RL, Bucklin M, Kelly M, et al. Insertional Achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion. J Orthop Res 2017;35(4):910–915.
28. Irwin TA. Current concepts review: insertional Achilles tendinopathy. Foot Ankle Int 2010;31(10):933–939.
29. Ohberg L, Alfredson H. Sclerosing therapy in chronic Achilles tendon insertional pain—Results of a pilot study. Knee Surg Sports Traumatol Arthrosc 2003;11(5):339–343.
30. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials. Lancet 2010;376(9754):1751–1767.
31. Kearney RS, Parsons N, Metcalfe D, et al. Injection therapies for Achilles tendinopathy. Cochrane Database Syst Rev. 2015;5:CD010960.
32. Monto RR. Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int 2012;33(5):379–385.
33. Garth Hunte, Rob Lloyd-Smith. Topical glyceryl trinitrate for chronic Achilles tendinopathy. Clin J Sport Med Affiliations expand 2005 Mar;15(2):116-7.
34. Marc Stevens, Chee-Wee Tan. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. Affiliations expand J Orthop Sports Phys Ther 2014 Feb;44(2):59-67.
35. Triantafyllopoulou AI, Karampitianis S, Galanos A, et al. The effect of a pharmaceutical per os supplement based on methylsulfonylmethane, hydrolyzed collagen, bromelain, D-glucosamine, chondroitin sulfate, L-arginine, L-lysine, plant extracts of boswellia, myrr and turmeric, and Vitamin C on Achilles tendinopathy. Acta Orthopaedica et Traumatologica Hellenica 2022 Vol 73(2): 136-144.
2. Karjalainen PT, Soila K, Aronen HJ, et al. MR imaging of overuse injuries of the Achilles tendon. Am J Roentgenol 2000;175(1):251–260.
3. Phisitkul P. Endoscopic surgery of the Achilles tendon. Curr Rev Musculoskelet Med 2012;5(2):156–163.
4. Saltzman C, Bonar S. Tendon problems of the foot and ankle. In: Lutter LD, Mizel MS, Pfeffer GB, eds. Orthopaedic Knowledge Update: Foot and Ankle. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1994:236-73.
5. Lohrer H, Arentz S, Nauck T, et al. The Achilles tendon insertion is crescent-shaped: an in vitro anatomic investigation. Clin Orthop Relat Res 2008;466(9):2230–2237.
6. Knobloch K, Kraemer R, Lichtenberg A, et al. Achilles tendon and paratendon microcirculation in midportion and insertional tendinopathy in athletes. Am J Sports Med 2006;34(1):92–97.
7. Benjamin M, Theobald P, Suzuki D, Toumi H. The Anatomy of the Achilles tendon. In: Maffulli N, Almekinders L, editors. The Achilles Tendon. London: Springer-Verlag; 2007. pp. 5–16.
8. Klauser AS, Miyamoto H, Tamegger M, et al. Achilles tendon assessed with sonoelastography: histologic agreement. Radiology 2013;267(3):837–842.
9. Nicholson CW, Berlet GC, Lee TH. Prediction of the success of nonoperative treatment of insertional Achilles tendinosis based on MRI. Foot Ankle Int 2007;28(4):472–477.
10. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int 2012;33(6):487–491.
11. Chimenti RL, Chimenti PC, Buckley MR, et al. Utility of ultrasound for imaging osteophytes in patients with insertional Achilles tendinopathy. Arch Phys Med Rehabil 2016;97(7):1206–1209.
12. Andrew G, Jonathan S. Comparison of Achilles tendon loading between male and female recreational runners. J Hum Kinet 2014; 44:155–159.
13. Farris DJ, Buckeridge E, Trewartha G, et al. The effects of orthotic heel lifts on Achilles tendon force and strain during running. J Appl Biomech 2012;28(5):511–519.
14. Franz JR, Slane LC, Rasske K, et al. Non-uniform in vivo deformations of the human Achilles tendon during walking. Gait Posture 2015;41(1):192–197.
15. Benjamin M, Rufai A, Ralphs JR. The mechanism of formation of bony spurs (enthesophytes) in the Achilles tendon. Arthritis Rheum 2000;43(3):576–583.
16. MN van Sterkenburg, Muller B, Maas M, et al. Appearance of the weight-bearing lateral radiograph in retrocalcaneal bursitis. Acta Orthop 2010;81(3):387–390.
17. Fahlstrom M, Jonsson P, Lorentzon R, et al. Chronic Achilles tendon pain treated with eccentric calf-muscle training. Knee Surg Sports Traumatol Arthrosc 2003;11(5):327–333.
18. Jonsson P, Alfredson H, Sunding K, et al. New regimen for eccentric calf-muscle training in patients with chronic insertional Achilles tendinopathy: results of a pilot study. Br J Sports Med 2008;42(9):746–749.
19. Rompe JD, Furia J, Maffulli N. Eccentric loading compared with shock wave treatment for chronic insertional Achilles tendinopathy. A randomized, controlled trial. J Bone Joint Surg Am 2008;90(1):52–61.
20. Kedia M, Williams M, Jain L, et al. The effects of conventional physical therapy and eccentric strengthening for insertional Achilles tendinopathy. Int J Sports Phys Ther 2014;9(4):488–497.
21. McCormack JR, Underwood FB, Slaven EJ, et al. Eccentric exercise versus eccentric exercise and soft tissue treatment (Astym) in the management of insertional Achilles tendinopathy: a randomized controlled trial. Sports Health 2016;8(3):230–237.
22. Furia JP. High-energy extracorporeal shock wave therapy as a treatment for insertional Achilles tendinopathy. Am J Sports Med 2006;34(5):733–740.
23. Wei M, Liu Y, Li Z, et al. Comparison of clinical efficacy among endoscopy-assisted radio-frequency ablation, extracorporeal shockwaves, and eccentric exercises in treatment of insertional Achilles tendinosis. J Am Podiatr Med Assoc 2017;107(1):11–16.
24. Lee JY, Yoon K, Yi Y, et al. Long-term outcome and factors affecting prognosis of extracorporeal shockwave therapy for chronic refractory Achilles tendinopathy. Ann Rehabil Med 2017;41(1):42–50.
25. Taylor J, Dunkerley S, Silver D, et al. Extracorporeal shock-wave therapy (ESWT) for refractory Achilles tendinopathy: a prospective audit with 2-year follow up. Foot (Edinb) 2016; 26:23–29.
26. S de Jonge, RJ de Vos, Van Schie HT, et al. One-year follow-up of a randomized controlled trial on added splinting to eccentric exercises in chronic midportion Achilles tendinopathy. Br J Sports Med 2010;44(9):673–677.
27. Chimenti RL, Bucklin M, Kelly M, et al. Insertional Achilles tendinopathy associated with altered transverse compressive and axial tensile strain during ankle dorsiflexion. J Orthop Res 2017;35(4):910–915.
28. Irwin TA. Current concepts review: insertional Achilles tendinopathy. Foot Ankle Int 2010;31(10):933–939.
29. Ohberg L, Alfredson H. Sclerosing therapy in chronic Achilles tendon insertional pain—Results of a pilot study. Knee Surg Sports Traumatol Arthrosc 2003;11(5):339–343.
30. Coombes BK, Bisset L, Vicenzino B. Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomized controlled trials. Lancet 2010;376(9754):1751–1767.
31. Kearney RS, Parsons N, Metcalfe D, et al. Injection therapies for Achilles tendinopathy. Cochrane Database Syst Rev. 2015;5:CD010960.
32. Monto RR. Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int 2012;33(5):379–385.
33. Garth Hunte, Rob Lloyd-Smith. Topical glyceryl trinitrate for chronic Achilles tendinopathy. Clin J Sport Med Affiliations expand 2005 Mar;15(2):116-7.
34. Marc Stevens, Chee-Wee Tan. Effectiveness of the Alfredson protocol compared with a lower repetition-volume protocol for midportion Achilles tendinopathy: a randomized controlled trial. Affiliations expand J Orthop Sports Phys Ther 2014 Feb;44(2):59-67.
35. Triantafyllopoulou AI, Karampitianis S, Galanos A, et al. The effect of a pharmaceutical per os supplement based on methylsulfonylmethane, hydrolyzed collagen, bromelain, D-glucosamine, chondroitin sulfate, L-arginine, L-lysine, plant extracts of boswellia, myrr and turmeric, and Vitamin C on Achilles tendinopathy. Acta Orthopaedica et Traumatologica Hellenica 2022 Vol 73(2): 136-144.
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