Achilles tendon pathologies can be divided into different categories:

1. Achillodynia: A painful overload of the Achilles tendon, often associated with mild inflammatory processes.

2. Achilles tendinosis: Degenerative changes of the tendon, usually chronic and often associated with calcification.

3. Insertional tendinopathy: Pain and inflammation at the insertion of the tendon on the heel bone.

4. Achilles tendon rupture: A complete or partial tear of the tendon, often caused by acute overload.

5. Retrocalcaneal bursitis: Inflammation of the bursa between the heel and the tendon, often accompanied by tenderness.

The main causes of Achilles tendon pathologies can be divided into several categories:

Mechanical overload:

Intensive sports activities, such as running, jumping, or other explosive movements, subject the Achilles tendon to enormous forces.

Repeated stress without sufficient recovery phases can cause microtrauma and overload damage.

Misalignments:

Foot deformities (e.g., flatfoot or high arch) alter the load distribution and lead to excessive strain on the Achilles tendon.

Inappropriate footwear, especially shoes with insufficient cushioning, increases the risk.

Degenerative changes:

With increasing age, the Achilles tendon loses elasticity and resilience, making it more susceptible to injuries.

Chronic microtrauma can accelerate degenerative processes.

Inflammatory causes:

Diseases such as rheumatoid arthritis or infections can cause inflammatory changes in the tendon.

Acute injuries:

Direct trauma, such as a sudden rupture of the tendon during physical exertion, also belongs to Achilles tendon pathologies.

The symptoms vary depending on the type and severity of the pathology, but often include:

• Localized pain: Pain usually occurs at the junction between the tendon and heel (insertion) or in the middle area of the tendon.
• Swelling and thickening: The Achilles tendon may appear visibly thickened or swollen.
• Movement restrictions: Activities such as running, jumping, or even walking can be painful and restrict mobility.
• Tenderness: Even slight pressure on the tendon triggers pain.
• Crepitus: In inflammatory processes, crunching noises can be heard when moving the tendon.
• Sudden pain and loss of function: In the case of a tendon rupture, a loud popping sound is often heard, followed by severe pain and loss of function.

The diagnosis is made through a combination of medical history, physical examination, and imaging techniques:

- Medical History:

- The doctor asks about symptoms, duration of the illness, sports activities, and possible injuries.

- Physical Examination:

- Palpation of the Achilles tendon for swelling, tenderness, and thickening.

- Special tests, such as the Thompson test, help diagnose a tendon rupture.

- Imaging Techniques:

- Ultrasound: Shows inflammatory processes, tears, or thickening of the tendon.

- MRI: Provides detailed information about soft tissue damage, calcifications, or degenerative changes.

- X-ray: Useful in cases of suspected bony changes or calcifications.

Conservative Therapy

Most Achilles tendon pathologies can be treated without surgery:

• Rest and Load Reduction:

  • Avoidance of strenuous activities to give the tendon time to heal.

• Physiotherapy:

  • Stretching and Strengthening Exercises: Promote the elasticity and resilience of the tendon.
  • Eccentric Training: Counteracts degenerative processes.

• Shockwave Therapy (ESWT):

  • High-energy sound waves promote healing and relieve pain.

• Injections:

  • PRP (Platelet-Rich Plasma): Promotes tissue regeneration.
  • Hyaluronic Acid: Relieves inflammation and improves gliding ability.

• Orthotics:

  • Special shoe inserts or orthotics can relieve the tendon and support healing.

Surgical Therapy

In cases of severe or chronic pathologies as well as a tendon rupture, surgery is necessary:

• Debridement:
  • Removal of degeneratively altered tissue.

• Tendon Reconstruction:

  • Repair or reinforcement of the Achilles tendon in cases of extensive damage.

• Minimally Invasive Techniques:

  • Modern procedures allow for quick recovery and low risk.

• Rupture Treatment:

  • A complete rupture is surgically treated using suture techniques or tendon transfer.

To prevent Achilles tendon pathologies, the following measures are recommended:

1. Suitable footwear: With sufficient cushioning and arch support.
2. Warming up and stretching: Before sports, to optimally prepare the tendon.
3. Load management: Breaks and recovery times between intense training sessions.
4. Strengthening the calf muscles: Supports the Achilles tendon and improves its resilience.