Achilles tendonosis

Key features:

- Often gradual and insidious onset.

- Diagnosis is mainly made via history and examination. Imaging is not indicated in most cases, however, if there are atypical features such as sudden onset and significant swelling. U/S may be appropriate

- U/S features of tendonosis: neb-vascularity and fusiform thickening

- X-ray is indicated when: insertional tenderness or posterior impingement

- Pathophysiology of tendonosis is not fully understood. May be related to overtraining.

- Management:

• Rest (may need to be off sports for 4 - 6 weeks)
• Gradual return to activities
• Eccentric exercise program (12 weeks, 3 sets, 15 reps of slow heel drop)
• NSAIDs
• Autologous blood injection and platelet rich plasma injection 
• GTN patch + eccentric exercise