Achilles tendinopathy: some aspects of basic science and clinical management

sports medicine review - BJSM

Authors: D Kader, A Saxena, T Movin and N Maffulli

British Journal of Sports Medicine

2002; Volume 36: page 239-249

Kader et al reviewed almost 350 articles to provide an interesting review of the anatomy, pathology and management of Achilles tendon problems in the British Journal of Sports Medicine. The article is comprehensive and provides essential reading for all clinicians who specialise in Sports Medicine. It also provides interesting information for those people, sporting or otherwise, who are suffering from Achilles tendon dysfunction.

You'll note we don't refer exclusively to sports participants, as the authors point out that although those involved in running sports are particularly susceptible, non-sporting individuals can also suffer from Achilles tendon problems. One of the biggest factors associated with non-sporting acquisition of Achilles tendon problems (and tendon problems in general) is the use of Quinolone antibiotics (such as Ciproxin, Raxar, Cinobac, Tavanic, Mictral, Utinor and Taravid) that are prescribed for urinary tract or chest infections. Advice published by the British Medical Association states that at the first sign of pain in a tendon, patients should discontinue the Quinilone medication and rest the affected tendon.

In the title of the article, Kader et al refer to 'tendonopathy' as an umbrella term for tendon dysfunction. This includes the conditions of 'tendonitis' and 'tendonosis'. Tendonitis is inflammation of a tendon, whereas tendonosis refers to degeneration of a tendon. Kader et al cite studies of tendon cell health which conclude that most Achilles tendonopathies are degenerative in nature and therefore termed Achilles tendonosis. In fact, this research shows that Achilles tendonosis is much more widespread than Achilles tendonitis, the term that was historically given to all Achilles tendon problems.

The authors cite previous research by Jozsa and Kannus (1997), that defines tendonosis as intratendinous degeneration - breakdown of tendon tissue. The authors also cite Leadbetter (1992) who proposed that tendinosis is a failure of cell matrix adaptation to trauma because of an imbalance between matrix degeneration and synthesis. Put simply, this means tendon healing can't keep pace with tendon damage.

Kader et al state that changes in training pattern, poor technique, previous injuries, footwear, and environmental factors such as training on hard, slippery, or slanting surfaces are factors that may predispose the athlete to Achilles tendinopathy. However, the authors point out that these are causation theories, and despite good face validity, a cause-effect relationship has not been demonstrated explicitily in controlled studies.

In summary, the authors stated that tendonopathy can probably be prevented by encouraging athletes and coaches to follow a sensible training programme. By seeking medical attention at an early stage the outcome may be improved, as treatment of tendonopathies is much more difficult when the condition becomes chronic.

Read the full research text >

Related articles:

Achilles tendonitis explained >
Achilles tendonosis explained >

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