In classical Greek mythology Achilles was a hero of the Trojan War. Legend has it that Achilles was invulnerable in all areas of his body except for his heel which later led to his death when he was shot by an arrow to his heal.

Clearly Greek writers knew of the underlying weakness and problems associated with this tendon and developed these great fables around it. This probably makes Achilles the first recorded episode of tendonitis!

Achilles tendonitis

Achilles tendonitis is one of the most common sports injuries. The tendon which is located behind the ankle can be inflamed by a change in the type and intensity of activity.

Some authors suggest that non-optimal lower limb biomechanics play a role in the development of this condition by placing excessive rotational stresses on the Achilles tendon and that this contributes to its degeneration.

Additionally, vascular changes in the tissue structure of the tendons have been demonstrated. This may greatly change the tensile strength of the tissue and contribute to further degeneration and slow healing frequently observed with this condition. The cause of this vascular change is unknown and may be contributed by several factors or may in be part of normal tissue aging.

Further research is needed in this area to fully characterise the development of this condition such that optimal treatment strategies can be applied.

Achilles Tendonitis - A tale of two different types of injury

Typically patients who present with Achilles pain often report pain in one of two distinct areas i.e. the insertion of the Tendon in to the heal bone and in the peritendon itself. It is possible that these different locations will be associated with two different types of pathology but currently little is known regarding their aetiology.

Achilles Tendonitis - Should I have a corticosteroid injection?

In Shrier et al. (1996) completed a comprehensive review of the evidence regarding the usefulness of corticosteroids. These authors concluded that to date the scientific research evidence was inconclusive.

As with all treatments there are risks of associated with using steroid injections which may include complete rupture of the tendon. In animal studies, corticosteroid injections decrease adhesion formation, temporarily weaken the tendon if given intratendinously, but have no effect on tendon strength if injected into the paratendon.

References

Shrier, I., Matheson, G., Kohl, H. (1996)

Achilles Tendonitis: Are Corticosteroid Injections Useful or Harmful?

Clinical Journal of Sport Medicine: October 1996 - Volume 6 - Issue 4