Achilles tendinopathy - Part 1
Aetiology, diagnosis and non-surgical management.
Keywords:Achilles tendinopathy, tendon, sports, eccentric exercises
Non-insertional Achilles tendinopathy is by far the most common condition affecting this strong tendon and the incidence is on the rise due to increasing participation in recreational sports worldwide. Although the exact aetiology of Achilles tendinopathy is poorly understood, recent advances in understanding the pathophysiology of this condition have aided clinicians in developing improved methods of preventing and treating this painful, ubiquitous problem. Several contributing factors have been identified but repetitive microtrauma and inadequate, pathological healing appear to be the main culprits. Diagnosis is clinical but can be aided by the judicious use of imaging in equivocal cases. Activity modification and non-surgical modalities form the mainstay of treatment, with eccentric exercise programmes showing the best outcomes in prospective series. Several other non-surgical modalities exist and many show promising preliminary results. Surgical treatment options are discussed in Part 2 of this review, which will be published in Vol 14 No 4 of this journal.