Several inflammatory and degenerative conditions fall under this heading, including tendinitis, tendinosis and insertional tendinitis. They may be the result of an acute injury triggered by functional over-loading, or repetitive microtraumas typically caused by unsuitable footwear, hard terrain or exercising in low temperatures.
Initially, symptoms tend to worsen during rest before easing after movement (the first few steps taken on a morning can be particularly uncomfortable). After some time, the pain may no longer ease after movement, severely hindering the patient’s movement. Over time, stress on the distal portion of the tendon can lead to inflammation of the pre-achilles bursa, further complicating the clinical situation.
Diagnosis is based on the localisation of pain (usually found around where the tendon inserts into the calcaneus) as well as swelling and flushing of the skin. These indicators are usually supported by an ultrasound scan, used to more accurately determine the location and extent of the lesion.
Tendinopathy requires delicate treatment and the chances of success vary depending on the severity of the injury and time since the onset of symptoms. Regardless, planning an effective rehabilitation program is still important as the later, less severe stages of the condition must not be ignored.