Achilles tendon disorders

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1262 (Published 12 March 2013)
Cite this as: BMJ 2013;346:f1262

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  1. Chad A Asplund, director of military sports medicine1,
  2. Thomas M Best, professor and pomerene chair2
  1. 1Department of Family Medicine, Eisenhower Army Medical Center, Fort Gordon, GA 30905, USA
  2. 2Division of Sports Medicine, Department of Family Medicine, Ohio State University, Columbus, OH 43221, USA
  1. Correspondence to: C A Asplund chad.asplund{at}gmail.com

Summary points

  • Midsubstance Achilles tendinopathy is more common than the insertional variant

  • Rupture is most common in men in the fourth and fifth decades of life

  • Eccentric exercises are the best treatment for Achilles tendinopathy

  • Other modalities such as shock wave therapy are additive to eccentric exercises in the treatment of recalcitrant Achilles tendinopathy

  • Early weight bearing and progressive rehabilitation improve outcomes for the non-operative management of Achilles tendon rupture

Disorders of the Achilles tendon are common in active people—competitive and recreational athletes alike—but they can occur in less active people. As the largest tendon in the body, the Achilles experiences repetitive strain from running, jumping, and sudden acceleration or deceleration, so is susceptible to rupture and degenerative changes. This review aims to describe the anatomy and diagnostic evaluation of the Achilles tendon, and to discuss the best available evidence to help in the management of Achilles tendon disorders.

Sources and selection criteria

We searched Medline (to include the Cochrane database) with the terms tendinopathy, Achilles tendon, tendon injuries, and Achilles tendon disorders. This was further limited to Achilles and finally to English language, human subjects within the past five years, and randomized controlled trials or evidence based reviews. The search yielded 70 references. We reviewed the abstracts of these 70 references and 57 met the inclusion criteria. Further landmark studies were added.

What are Achilles tendon disorders?

The Achilles tendon is the strongest tendon in the body,1 serving both the gastrocnemius and soleus muscles. It begins near the mid-calf and inserts posteriorly at the calcaneus (fig 1). In the region where the tendon joins the bone, there is an amalgam called the enthesis organ, in which the tissue is a composite of bone and tendon.2 Kager’s fat pad is located anterior to the Achilles tendon and posterior to the calcaneus, forms the superior border of this enthesis …

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