Achilles tendonitis; posterior tibial tendonitis

Etiology

(contributing factors)

• in the elderly
  • pes planus
  • posterior tibial muscle weakness
  • subtalar arthritis

* Achilles' enthesitis in spondyloarthritis including Reiter's syndrome

Pathology

• no inflammation on histopathology, thus a tendinopathy rather than tendonitis

Clinical manifestations

• burning heel pain & stiffness that worsens with activity & improves with rest
• symptoms generally occur after patient increases level of activity
• chronic swelling along the Achilles tendon
• maximal tenderness 4-5 cm proximal to the calcaneal insertion (range 2-6 cm), or as tender swelling at the point of insertion (insertional tendonitis)

Management

• orthotics
• Achilles tendon stretching exercises
• glucocorticoid/local anesthetic injection
  • inject into the retrocalcaneal bursa
  • injection of the tendon itself may lead to rupture
• high-volume saline injections of no benefit
• injection of platelet-rich plasma of no benefit

More general terms

• tendonitis (tendon injury)

Additional terms

• Achilles/calcaneal/heel tendon (chorda magna, tendo calcaneus)
• joint/bursa injection (knee injection, subacromial bursa injection)
• pes planus
• retrocalcaneal bursa; achilles bursa; bursa of calcaneal tendon