The Achilles tendon, also known as the calcaneal tendon or heel cord, connects the calf muscles (gastrocnemeus and soleus) to the calcaneus (heel bone).  As the gastrocnemeus and soleus contract, the tendon pulls up on the calcaneus, plantar flexing the foot. Tendinopathy means disease of the tendon.  Tendinitis means inflammation of the tendon and is a type of tendinopathy.  Tendinosis, another type of tendinopathy is when the tendon tissue becomes degenerative in response to repetitive or chronic injury. 

Symptoms: • Pain in the back of the heel • Pain is worse with strenuous activity Physical exam: • Tenderness at or just proximal to the insertion of the Achilles tendon on the calcaneus • Deficit or deformity of the heel cord (although this may be difficult to appreciate because of swelling) • A positive Thompson test indicates a complete rupture of the Achilles tendon • A Haglund’s deformity (pump bump) can contribute to Achilles tendinosis • Tenderness directly over the posterior calcaneus suggests calcaneal bursitis rather than Achilles tendinopathy Imaging: • X-rays are obtained to rule out other causes of heel pain including posterior ankle impingement, Haglund’s deformity, and avulsion fractures of the calcaneal tuberosity • X-rays may demonstrate an associated Haglund’s deformity and/or calcification of the Achilles tendon • Ultrasound can be used to confirm the diagnosis of a ruptured Achilles tendon • MRI provides better detail than ultrasound and can be used to evaluate tendinopathy and partial tears or confirm the presence of a complete tear Treatment (tendinitis): • Avoid strenuous activity, especially explosive sports • Ice • NSAIDs • Comfortable footwear with a heel lift • In more severe cases, it may be necessary to immobilize the ankle in a CAM walker boot with a heel lift • Physical therapy may be helpful once the tendon has begun to heal Treatment (tendinosis greater than 3 months) • Treatment focuses on stimulating growth of healthy tendon tissue to replace damaged tissue • Physical therapy, including eccentric exercises and heel cord stretching •  PRP injections and autologous blood injections have been proposed as treatments for Achilles tendinopathy, but have not proven beneficial