Merck Manual

Please confirm that you are a health care professional

honeypot link

Achilles Tendon Enthesopathy

By

Kendrick Alan Whitney

, DPM, Temple University School of Podiatric Medicine

Last full review/revision Dec 2019| Content last modified Dec 2019
Click here for Patient Education
Topic Resources

Achilles tendon enthesopathy is pain at the insertion of the Achilles tendon at the posterosuperior aspect of the calcaneus. Diagnosis is clinical. Treatment is with stretching, splinting, and heel lifts.

The cause of Achilles tendon enthesopathy is chronic traction of the Achilles tendon on the calcaneus. Contracted or shortened calf muscles (resulting from a sedentary lifestyle and obesity) and athletic overuse are factors. Enthesopathy may be caused by a spondyloarthropathy Overview of Seronegative Spondyloarthropathies Seronegative spondyloarthropathies (seronegative spondyloarthritides) share certain clinical characteristics (eg, inflammatory back pain, uveitis, gastrointestinal symptoms, rashes). Some are... read more . Fluoroquinolone antibiotics increase the risk of Achilles tendinopathy or tendon rupture especially in people over age 60.

Pain at the posterior heel below the top of the shoe counter during ambulation is characteristic. Pain on palpation of the tendon at its insertion in a patient with these symptoms is diagnostic. Manual dorsiflexion of the ankle during palpation usually exacerbates the pain. Recurrent and especially multifocal enthesitis should prompt evaluation (history and examination) for a spondyloarthropathy.

Treatment of Achilles Tendon Enthesopathy

  • Stretching, splinting, and heel lifts

Physical therapy is essential for home exercise programs aimed at calf muscle–stretching techniques, which should be done for about 10 minutes 2 to 3 times a day. The patient can exert pressure posteriorly to stretch the calf muscle while facing a wall at arms’ length, with knees extended and foot dorsiflexed by the patient's body weight. To minimize stress to the Achilles tendon with weight bearing, the patient should move the foot and ankle actively through their range of motion for about 1 minute when rising after extended periods of rest. Night splints may also be prescribed to provide passive stretch during sleep and help prevent contractures.

Heel lifts should be used temporarily to decrease tendon stress during weight bearing and relieve pain. Even if the pain is only in one heel, heel lifts should be used bilaterally to prevent gait disturbance and possible secondary (compensatory) hip and or low back pain.

For more recalcitrant forms of Achilles tendon enthesopathy, extracorporeal pulse activation therapy (EPAT) should be considered. In EPAT, low-frequency pulse waves are delivered locally using a handheld applicator. The pulsed pressure wave is a safe, noninvasive technique that stimulates metabolism and enhances blood circulation, which helps regenerate damaged tissue and accelerate healing.

Click here for Patient Education
NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
Professionals also read

Test your knowledge

Herniated Nucleus Pulposus
Herniated nucleus pulposus, or herniated disk, is prolapse of an intervertebral disk through a tear in the surrounding annulus fibrosis. Symptoms of a herniated disk may mimic symptoms of an epidural abscess; therefore, distinguishing between these two conditions is part of the initial history and physical examination. During the examination, which of the following findings is most likely in a patient with an epidural abscess rather than a lumbosacral herniation?
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID

Also of Interest

Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
Download the Manuals App iOS ANDROID
TOP