Feature Article

The Achilles tendon: focus on disorders in the athlete

Peter Lam
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Disorders of the Achilles tendon are common among runners and in athletes involved in running sports with repetitive jumping, such as soccer and basketball, and in ballet. The middle-aged weekend athlete is also at risk. Here, the clinical presentation and management of the spectrum of Achilles tendon pathology are reviewed. Nonoperative management can relieve pain in most patients.

Key Points

  • Pain in the Achilles tendon is very common in people who participate in running sports such as soccer, basketball and long distance running, and in ballet dancers. It is also common in middle-aged weekend athletes.
  • The spectrum of Achilles tendon disorders can be divided into noninsertional and insertional Achilles tendinitis.
  • For the vast majority of patients, good relief can be achieved using nonoperative measures. These include activity modification with stretching, the use of heel lifts (generally 0.5 to 1.5 cm), oral nonsteroidal anti-inflammatory medication and orthotics (if hindfoot malalignment is present).
  • Avoid corticosteroid injections into the Achilles tendon as the steroid will predispose the tendon to rupture.
  • If symptoms persist despite at least six months of nonoperative treatment then surgery may be required.