Introduction

Achilles tendon disorders are the most common cause of posterior heel pain. Possible presentations include tendinopathy (tendinitis), partial tear and complete rupture of the Achilles tendon.

Epidemiology

  • Incidence: 230.00 cases per 100,000 person-years
  • Peak incidence: 40-50 years
  • Sex ratio: 1:1
Condition Relative
incidence
Achilles tendon disorders1
Calcaneal apophysitis (Sever disease) 0.22
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Aetiology

Risk factors
  • quinolone use (e.g. ciprofloxacin) is associated with tendon disorders
  • hypercholesterolaemia (predisposes to tendon xanthomata)

Clinical features

Achilles tendinopathy (tendinitis)

Features
  • gradual onset of posterior heel pain that is worse following activity
  • morning pain and stiffness are common
  • calf muscle eccentric exercises - this may be self-directed or under the guidance of physiotherapy


Achilles tendon rupture

Achilles tendon rupture should be suspected if the person describes the following whilst playing a sport or running; an audible 'pop' in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport.

An examination should be conducted using Simmond's triad, to help exclude Achilles tendon rupture. This can be performed by asking the patient to lie prone with their feet over the edge of the bed. The examiner should look for an abnormal angle of declination; Achilles tendon rupture may lead to greater dorsiflexion of the injured foot compared to the uninjured limb. They should also feel for a gap in the tendon and gently squeeze the calf muscles if there is an acute rupture of the Achilles tendon the injured foot will stay in the neutral position when the calf is squeezed.

Management

Achilles tendinopathy (tendinitis)

The management is typically supportive including simple analgesia and reduction in precipitating activities.


Achilles tendon rupture

An acute referral should be made to an orthopaedic specialist following a suspected rupture.