Page 21 - 2020 ISAKOS Newsletter Volume I
P. 21
Insertional Achilles Tendinopathy
Introduction
Gian Luigi Canata, MD
Centre of Sports Traumatology, Koelliker Hospital, Torino, ITALY
Valentina Casale, MD
Centre of Sports Traumatology, Koelliker Hospital, Torino, ITALY
Insertional Achilles tendinopathy is a painful and debilitating condition, representing approximately one-third of all Achilles tendon abnormalities. Patients of all ages and activity levels may be affected, especially running athletes.
Overuse injuries of the Achilles tendon include both insertional tendinopathies (at the calcaneus-Achilles tendon junction) and non-insertional tendinopathies (2 to 6 cm proximal to the calcaneus-Achilles tendon junction)1. Among insertional tendinopathies, a clear distinction should be made between Haglund disease and all other insertional pathologies. In fact, the term Haglund exostosis is commonly used to describe a clinical condition characterized by pain and tenderness at the posterolateral side of the calcaneus, where a calcaneal prominence can often be felt1. This pathology is better classified as a “pre- insertional” tendinopathy and may coexist with insertional affections2. (Fig. 1).
01 Radiograph showing a Haglund calcaneal prominence and calcific insertional Achilles tendinopathy.
The etiology of insertional Achilles tendinopathy is multifactorial, and several predisposing factors have been proposed. Intrinsic risk factors include hyperpronation, pes cavus, leg-length discrepancy, limited mobility of the subtalar joint, advancing age, obesity, diabetes, hypertension, and use of steroids, estrogens, and fluoroquinolone antibiotics. Extrinsic predisposing factors include changes in training pattern, footwear, and running on hard, and sloping surfaces3.
According to some authors, the affected site may be defined as “stress-shielded.” When inflammation is prolonged, the bursa may become fibrotic, resulting in a reduction of its lubricating function. Repetitive trauma results in cartilage-like changes within the Achilles tendon, leading to intratendinous bone formation through endochondral ossification4.
CURRENT CONCEPTS
ISAKOS NEWSLETTER 2020: VOLUME I 19
