Achilles tendinosis is often confused withAchilles tendonitis, which is acute (sudden onset) inflammation of the tendon.Distinguishing these conditionsis important to ensure proper treatment.
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Inflammation vs. Degeneration
And sometimes, if recurrent or sudden trauma causes tendon damageandinflammation, you can have both.
Achilles Tendonitis
Achilles tendonitis is an acute inflammation of the Achilles tendon. “Acute” inflammation means that the inflammation is active. This kind of inflammation involves redness, warmth, pain, and swelling.
On a microscopic level, specific cells can be seen in inflammatory conditions—your body brings these cells to the affected area in order to manage inflammation and heal the injured tendon.With Achilles tendonitis, there is no underlying permanent change In the tendon.
Achilles Tendinosis
Achilles tendinosis is a thickening of the tendon. It causes pain, but there is typically no warmth or redness surrounding the soft tissues,
Achilles tendinosis is a chronic problem. This means that it is a long-term condition that develops over time. Microscopically, very small tears of the tendon may be seen along with chronic damage.
This condition is diagnosed based on symptoms. AnX-rayof the ankle joint might be normal, although it is possible to see small calcific deposits or bone spurs around the tendon. These are signs of chronic inflammation.An MRI test may show microscopic tearing or degeneration of the tendon tissue, as well as thickening of the damaged portion of the tendon.
Treatment
While the treatment of Achilles tendonitis and Achilles tendinosis are similar, they are not always the same.
The more effective treatments for Achilles tendinosis tend to be shoe inserts, therapeutic exercises, and stretching.
Medication
Modalities aimed to reduce inflammation (ice, anti-inflammatory medications) will likely do very little to help resolve Achilles tendinosis.Anti-inflammatory medications(NSAIDs) and ice applications may be used to treat symptoms of discomfort associated with Achilles tendinosis, but they don’t treat the underlying problem.
Achilles tendonitis is treated with therapies that reduce inflammation.
Achilles tendinitis and Achilles tendinosis are not mutually exclusive—you can have both. Chronic Achilles tendinosis can become acutely inflamed due to overuse or an acute injury. In this case, it would cause warmth and swelling. Your healthcare provider may prescribe NSAIDs and rest to calm down flared-up chronic tendinosis before initiating other treatments like physical therapy.
Surgery
Your surgeon may recommend surgical treatment of the damaged tendon.In these cases, most often the damaged portion of the tendon is surgically removed. Once the abnormal tendon is removed, the surrounding tendon can be repaired around the defect.
A Word From Verywell
Achilles tendon problems may differ in their cause, symptoms, and treatment. One important distinction is to determine if the cause of the problem is inflammation or chronic degeneration. Achilles tendinosis is a problem that results from chronic breakdown and deterioration of the tendon tissue. Unlike an inflammatory problem, Achilles tendinosis tends to respond much better to therapeutic treatments rather than treatments to reduce inflammation. This is why it is critical to determine the source of your Achilles pain, rather than just the location.
Posterior Heel Pain Causes and Treatment
10 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG.The risk of achilles tendon rupture in the patients with achilles tendinopathy: healthcare database analysis in the United States.BioMed Research International. 2017;2017:1-4. doi: 10.1155/2017/7021862Evelyn Bass LMT.Tendinopathy: why the difference between tendinitis and tendinosis matters.International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. 2012;5(1):14-17. doi: 10.3822%2Fijtmb.v5i1.153Chen L, Deng H, Cui H, et al.Inflammatory responses and inflammation-associated diseases in organs.Oncotarget. 2017;9(6):7204-7218. doi: 10.18632/oncotarget.23208Aurora Health Care.Knee, shoulder & elbow cracking or popping (crepitus).Wu YS, Chen SN.Apoptotic cell: linkage of inflammation and wound healing.Front Pharmacol. 2014;5. doi: 10.3389/fphar.2014.00001Kulig K, Chang YJ, Ortiz-Weissberg D.A perspective on reversibility of tendinosis-induced multi-level adaptations.Front Physiol. 2020;11:651. doi: 10.3389/fphys.2020.00651Lowri B, Rhodri E, Owen B, Joshua H, Anne-Marie H.Investigating the validity of soft tissue signs on lateral ankle x-ray to aid diagnosis of achilles tendon rupture in the emergency department.Int J Foot Ankle. 2019;3(2). doi: 10.23937/2643-3885/1710033Szaro, P., Ghali Gataa, K.The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging.Sci Rep11, 6131 (2021). doi: 10.1038/s41598-021-85604-9Rabusin, C.L., Menz, H.B., McClelland, J.A.et al.Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial.J Foot Ankle Res12, 20 (2019). doi: 10.1186/s13047-019-0325-2ClinicalTrials.gov.Individualized Treatment of Acute Achilles Tendon Rupture.Additional ReadingReddy SS, Pedowitz DI, Parekh SG, Omar IM, Wapner KL.Surgical treatment for chronic disease and disorders of theachilles tendon. J AmAcadOrthopSurg. 2009 Jan;17(1):3-14.
10 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG.The risk of achilles tendon rupture in the patients with achilles tendinopathy: healthcare database analysis in the United States.BioMed Research International. 2017;2017:1-4. doi: 10.1155/2017/7021862Evelyn Bass LMT.Tendinopathy: why the difference between tendinitis and tendinosis matters.International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. 2012;5(1):14-17. doi: 10.3822%2Fijtmb.v5i1.153Chen L, Deng H, Cui H, et al.Inflammatory responses and inflammation-associated diseases in organs.Oncotarget. 2017;9(6):7204-7218. doi: 10.18632/oncotarget.23208Aurora Health Care.Knee, shoulder & elbow cracking or popping (crepitus).Wu YS, Chen SN.Apoptotic cell: linkage of inflammation and wound healing.Front Pharmacol. 2014;5. doi: 10.3389/fphar.2014.00001Kulig K, Chang YJ, Ortiz-Weissberg D.A perspective on reversibility of tendinosis-induced multi-level adaptations.Front Physiol. 2020;11:651. doi: 10.3389/fphys.2020.00651Lowri B, Rhodri E, Owen B, Joshua H, Anne-Marie H.Investigating the validity of soft tissue signs on lateral ankle x-ray to aid diagnosis of achilles tendon rupture in the emergency department.Int J Foot Ankle. 2019;3(2). doi: 10.23937/2643-3885/1710033Szaro, P., Ghali Gataa, K.The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging.Sci Rep11, 6131 (2021). doi: 10.1038/s41598-021-85604-9Rabusin, C.L., Menz, H.B., McClelland, J.A.et al.Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial.J Foot Ankle Res12, 20 (2019). doi: 10.1186/s13047-019-0325-2ClinicalTrials.gov.Individualized Treatment of Acute Achilles Tendon Rupture.Additional ReadingReddy SS, Pedowitz DI, Parekh SG, Omar IM, Wapner KL.Surgical treatment for chronic disease and disorders of theachilles tendon. J AmAcadOrthopSurg. 2009 Jan;17(1):3-14.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG.The risk of achilles tendon rupture in the patients with achilles tendinopathy: healthcare database analysis in the United States.BioMed Research International. 2017;2017:1-4. doi: 10.1155/2017/7021862Evelyn Bass LMT.Tendinopathy: why the difference between tendinitis and tendinosis matters.International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. 2012;5(1):14-17. doi: 10.3822%2Fijtmb.v5i1.153Chen L, Deng H, Cui H, et al.Inflammatory responses and inflammation-associated diseases in organs.Oncotarget. 2017;9(6):7204-7218. doi: 10.18632/oncotarget.23208Aurora Health Care.Knee, shoulder & elbow cracking or popping (crepitus).Wu YS, Chen SN.Apoptotic cell: linkage of inflammation and wound healing.Front Pharmacol. 2014;5. doi: 10.3389/fphar.2014.00001Kulig K, Chang YJ, Ortiz-Weissberg D.A perspective on reversibility of tendinosis-induced multi-level adaptations.Front Physiol. 2020;11:651. doi: 10.3389/fphys.2020.00651Lowri B, Rhodri E, Owen B, Joshua H, Anne-Marie H.Investigating the validity of soft tissue signs on lateral ankle x-ray to aid diagnosis of achilles tendon rupture in the emergency department.Int J Foot Ankle. 2019;3(2). doi: 10.23937/2643-3885/1710033Szaro, P., Ghali Gataa, K.The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging.Sci Rep11, 6131 (2021). doi: 10.1038/s41598-021-85604-9Rabusin, C.L., Menz, H.B., McClelland, J.A.et al.Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial.J Foot Ankle Res12, 20 (2019). doi: 10.1186/s13047-019-0325-2ClinicalTrials.gov.Individualized Treatment of Acute Achilles Tendon Rupture.
Yasui Y, Tonogai I, Rosenbaum AJ, Shimozono Y, Kawano H, Kennedy JG.The risk of achilles tendon rupture in the patients with achilles tendinopathy: healthcare database analysis in the United States.BioMed Research International. 2017;2017:1-4. doi: 10.1155/2017/7021862
Evelyn Bass LMT.Tendinopathy: why the difference between tendinitis and tendinosis matters.International Journal of Therapeutic Massage & Bodywork: Research, Education, & Practice. 2012;5(1):14-17. doi: 10.3822%2Fijtmb.v5i1.153
Chen L, Deng H, Cui H, et al.Inflammatory responses and inflammation-associated diseases in organs.Oncotarget. 2017;9(6):7204-7218. doi: 10.18632/oncotarget.23208
Aurora Health Care.Knee, shoulder & elbow cracking or popping (crepitus).
Wu YS, Chen SN.Apoptotic cell: linkage of inflammation and wound healing.Front Pharmacol. 2014;5. doi: 10.3389/fphar.2014.00001
Kulig K, Chang YJ, Ortiz-Weissberg D.A perspective on reversibility of tendinosis-induced multi-level adaptations.Front Physiol. 2020;11:651. doi: 10.3389/fphys.2020.00651
Lowri B, Rhodri E, Owen B, Joshua H, Anne-Marie H.Investigating the validity of soft tissue signs on lateral ankle x-ray to aid diagnosis of achilles tendon rupture in the emergency department.Int J Foot Ankle. 2019;3(2). doi: 10.23937/2643-3885/1710033
Szaro, P., Ghali Gataa, K.The correlations between dimensions of the normal tendon and tendinopathy changed Achilles tendon in routine magnetic resonance imaging.Sci Rep11, 6131 (2021). doi: 10.1038/s41598-021-85604-9
Rabusin, C.L., Menz, H.B., McClelland, J.A.et al.Efficacy of heel lifts versus calf muscle eccentric exercise for mid-portion Achilles tendinopathy (the HEALTHY trial): study protocol for a randomised trial.J Foot Ankle Res12, 20 (2019). doi: 10.1186/s13047-019-0325-2
ClinicalTrials.gov.Individualized Treatment of Acute Achilles Tendon Rupture.
Reddy SS, Pedowitz DI, Parekh SG, Omar IM, Wapner KL.Surgical treatment for chronic disease and disorders of theachilles tendon. J AmAcadOrthopSurg. 2009 Jan;17(1):3-14.
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