The Achilles tendon

Often, and inaccurately, any pain around the Achilles is referred to as Achilles tendonitis. Achilles tendonitis refers to one specific and defined pathology of several which exist, and can co-exist. It is useful to divide the different problems of the Achilles tendon into those which affect the main body of the Achilles tendon. These conditions are tendonitis, tendonosis and rupture and those conditions which affect the insertion of the Achilles tendon into the bone (insertional tendonosis of the Achilles tendon, a Hagglunds deformity).

What sort of problems exist?
Problems can be separated into two main groups. These are the Achilles tendon ruptures, and the chronically painful Achilles tendon. (These groups do actually overlap as the chronically painful tendon may rupture and after a rupture a tendon may become chronically painful).

The Chronically Painful Achilles Tendon
Pain may originate either from (1) the main body of the Achilles tendon or (2) where it inserts into the heel bone.

A pronounced bony insertional deformity (both sides) with a chronically thickened and degenerate tendon inserting into it on the left side.

1) The main body of the tendon may be painful due to either Achilles tendonitis (an inflammation of the superficial covering of the tendon) or Achilles tendinosis (degeneration of the substance of the tendon).

An area of Achilles tendinosis. The abnormal section of tendon is thicker and whiter and its longitudinal fibres less well defined.

2) Insertional pain can originate from a healthy tendon being compressed by a prominent heel bone (known as a Hagglunds deformity). Alternatively the inserting tendon may have undergone degenerative changes as well (tendinosis).

A right sided Hagglunds deformity, normal left side.