Overuse injuries of the Achilles tendon are common in patients engaging in recreational athletics. Achilles tendon
overuse injuries exist as a spectrum of diseases ranging from
inflammation of the paratendinous tissue (paratenonitis), to structural degeneration of the tendon (
tendinosis), and finally tendon
rupture. Factors known to predispose patients to Achilles
tendinitis include inadequate stretching, training errors, mechanical malalignment of the lower extremities, rigid training surfaces, and occasionally systemic disease. Treatment of the patient with paratenonitis and
tendinosis is initially conservative, emphasizing
passive stretching, concentric and eccentric strengthening, correction of training errors, and restoration of normal limb alignment. Patients resistant to this protocol often exhibit a more advanced degree of tendon change. A high percentage of these patients can benefit from surgical
debridement of the involved tendon, and they can anticipate successful return to recreational athletics.
Steroid injections should not be routinely used in patients with Achilles
tendinitis.
Rupture of the Achilles tendon following intratendinous injection has been reported.