Achilles Tendinosis

Tendinosis Causes Chronic Tendon Damage, Not Sudden Inflammation

Achilles pain
The Achilles tendon is a common source of ankle pain. Jan-Otto/E+/Getty Images

Achilles tendinosis is a common problem of the Achilles tendon. Unfortunately, many patients and doctors alike confuse the term Achilles tendonitis with Achilles tendinosis. Achilles tendinosis is a chronic problem that is characterized by microscopic tears of the Achilles tendon. On the other hand, Achilles tendonitis occurs when there is acute (sudden onset) inflammation of the tendon.  Distinguishing these conditions is important to ensure proper treatment.

Inflammation vs. Degeneration

The term Achilles tendonitis should be used to refer to inflammation of the Achilles tendon. Inflammation is most often an acute change (the result of a sudden injury). This problem is characterized by swelling, redness, warmth, and pain. One common symptom of Achilles tendonitis is called crepitus.  Crepitus is a grinding sensation that can be felt by placing your hand over a moving tendon.  The inflammation and swelling of the tendon causes a grinding sensation that can be felt by your hand.  When seen under the microscope, inflammatory conditions have specific cells that the body brings to that area of the body to help control the inflammation and heal the injured tendon.

Achilles tendinosis is a different condition that is not characterized by inflammation. Rather, these patients have thickening of the tendon. There is usually no redness or warmth of the surrounding soft tissues, although the area can be painful to touch. Achilles tendinosis is a chronic problem, meaning it develops gradually and lasts a long time. When seen under a microscope, inflammatory cells are not present, although chronic damage and microscopic tears of the tendon may be seen.

The symptoms of Achilles tendinosis are the best way to make the diagnosis of this condition.  Typically an x-ray of the ankle joint will be normal, although it is possible to see small calcific deposits or bone spurs around the tendon, these are signs of chronic inflammation.  An MRI test can also be performed which may show the microscopic tearing or degeneration of the tendon tissue, as well as thickening of the damaged portion of the tendon.

It is important to distinguish between tendonitis and tendinosis, as the treatments for these condition will differ.  For example, treating Achilles tendinosis with modalities aimed to reduce inflammation (ice, anti-inflammatory medications) will likely do very little to help you resolve the symptoms of this condition. In a similar way, treatment of tendinosis when the problem is an inflammatory condition will be likely to be equally ineffective.

Treatment of Achilles Tendinosis

While the treatment of Achilles tendonitis and Achilles tendinosis are similar, they are not the same. It is important to note that because Achilles tendinosis lacks inflammation, treatments that are aimed at controlling inflammation are unlikely to be helpful. Therefore, while anti-inflammatory medications and ice application may be used to treat symptoms of discomfort associated with Achilles tendinosis, they are not fighting inflammation in this situation. The more effective treatments for Achilles tendinosis tend to be shoe inserts, therapeutic exercises, and stretching.

Specifically, exercises that focus on eccentric contraction of the Achilles tendon have been shown to be the most effective way to stimulate healing of the damaged portion of the tendon.  Eccentric contractions are performed by contracting the muscle tendon unit, while also providing a lengthening force.  For example, doing toe dips, and slowly dipping down is an effective eccentric exercise for the Achilles tendon.

In some rare situations, your surgeon may recommend surgical treatment of the damaged tendon. In these cases, most often the damaged portion of the tendon is surgically removed. Once the abnormal tendon is removed, the surrounding tendon can be repaired around the defect. There is controversy about how effective this treatment is in curing Achilles tendinosis. Some surgeons believe that the effectiveness of this treatment is really a result of the rehab that is done once the surgery has been done. 

A Word From Verywell

Achilles tendon problems may differ in both their cause and their treatment. One important distinction is to determine if the cause of the problem is inflammation, or a more chronic degeneration. Achilles tendinosis is a problem that results from chronic breakdown and deterioration of the tendon tissue. Unlike an inflammatory problem, Achilles tendinosis tends to respond much better to therapeutic treatments rather than treatments to reduce inflammation. This is why it is critical to determine the source of your Achilles pain, rather than just the location!

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