Research progress in Achilles tendinopathy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Weixin ¹ , LIU Peilong ² , LIANG Xiaojun ² ,  ZHAO Hongmou ²

1. Xi’an Medical University, Xi’an Shaanxi, 710068, P.R.China;
2. Department of Foot and Ankle Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;

Corresponding author：

ZHAO Hongmou, Email: zhao_hongmou@hotmail.com

Keywords：

Achilles tendinopathy; classification; diagnosis; treatment; research progress

DOI：

10.7507/1002-1892.202002064

Video：

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Objective To explore the classification, diagnosis, and clinical treatment of Achilles tendinopathy.Methods The literature about Achilles tendinopathy at home and abroad was reviewed. The research results of classification and terms, imaging diagnosis, and clinical treatment of Achilles tendinopathy were summarized.Results The classification and name of Achilles tendinopathy are not completely unified, and the concept is vague, the cause of disease is not clear. There are many treatment plans, but there is no effective evidence-based medicine research.Conclusion The diagnosis and treatment of Achilles tendinopathy is complicated. According to the characteristics of Achilles tendon anatomy and etiology, the classification and definition of Achilles tendinopathy need to be further studied in order to guide clinical treatment more effectively and facilitate experience exchange and learning.

Citation： ZHENG Weixin, LIU Peilong, LIANG Xiaojun, ZHAO Hongmou. Research progress in Achilles tendinopathy. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(12): 1619-1623. doi: 10.7507/1002-1892.202002064 Copy

1.	Mahan J, Damodar D, Trapana E, et al. Achilles tendon complex: The anatomy of its insertional footprint on the calcaneus and clinical implications. J Orthop, 2020, 17: 221-227.
2.	Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Med Arthrosc Rev, 2009, 17(2): 112-126.
3.	Syed TA, Perera A. A proposed staging classification for minimally invasive management of Haglund’s syndrome with percutaneous and endoscopic surgery. Foot & Ankle Clinics, 2016, 21(3): 641-664.
4.	Jennings MM, Liew V, Marine B. Updates in tendinopathy treatment options. Clin Podiatr Med Surg, 2019, 36(4): 543-552.
5.	李宏云, 徐翰林, 白露, 等. 跟腱止点性腱病临床治疗专家共识. 中国运动医学杂志, 2019, 38(10): 829-833.
6.	Ballal MS, Walker CR, Molloy AP. The anatomical footprint of the Achilles tendon: a cadaveric study. Bone Joint J, 2014, 96-B(10): 1344-1348.
7.	Jones FW, Peltier LF. Structure and function as seen in the foot. Clin Orthop Relat Res, 2001, (391): 3-6.
8.	Edama M, Masayoshi K, Onishi H, et al. Structure of the Achilles tendon at the insertion on the calcaneal tuberosity. J Anat, 2016, 229(5): 610-614.
9.	Maffulli N, Longo GU, Kadakia A, et al. Achilles tendinopathy. Foot Ankle Surg, 2019. https://doi.org/10.1016/j.fas.2019.03.009.
10.	Kvist M. Achilles tendon injuries in athletes. Sports Med, 1994, 18(3): 173-201.
11.	Myerson MS, McGarvey W. Disorders of the Achilles tendon insertion and Achilles tendinitis. Instr Course Lect, 1999, 48(3): 211-218.
12.	Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med, 1976, 4(4): 145-150.
13.	Kokubu S, Inaki R, Hoshi K, et al. Adipose-derived stem cells improve tendon repair and prevent ectopic ossification in tendinopathy by inhibiting inflammation and inducing neovascularization in the early stage of tendon healing. Regen Ther, 2020, 14: 103-110.
14.	Singh A, Calafi A, Diefenbach C, et al. Noninsertional tendinopathy of the Achilles. Foot Ankle Clin, 2017, 22(4): 745-760.
15.	Clain MR, Baxter DE. Achilles tendinitis. Foot Ankle, 1992, 13(8): 482-487.
16.	Feilmeier M. Noninsertional Achilles tendinopathy pathologic background and clinical examination. Clin Podiatr Med Surg, 2017, 34(2): 129-136.
17.	Eickler R, Pomeranz SJ. Achilles tendinitis. J Surg Orthop Adv, 2015, 24(3): 198-202.
18.	Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy, 1998, 14(8): 840-843.
19.	Pfeffer G, Gonzalez T, Zapf M, et al. Achilles pullout strength after open calcaneoplasty for Haglund’s syndrome. Foot Ankle Int, 2018, 39(8): 966-969.
20.	Jerosch J, Schunck J, Sokkar SH. Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund’s syndrome. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 927-934.
21.	Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int, 2012, 33(6): 487-491.
22.	桂鉴超, 顾湘杰, 王旭, 等. 跟腱末端病的诊断及手术治疗. 中华骨科杂志, 2007, 27(6): 413-416.
23.	Fowler A, Philip JF. Abnormality of the calcaneus as a cause of painful heel its diagnosis and operative treatment. Br J Surg, 2005, 32(128): 494-498.
24.	Pavlov H, Heneghan MA, Hersh A, et al. The Haglund syndrome: initial and differential diagnosis. Radiology, 1982, 144(1): 83-88.
25.	Wezenbeek E, Mahieu N, Willems TM, et al. What does normal tendon structure look like? New insights into tissue characterization in the Achilles tendon. Scand J Med Sci Sports, 2017, 27(7): 746-753.
26.	Abate M, Schiavone C, Salini V, et al. Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford), 2013, 52(4): 599-608.
27.	Vaishya R, Agarwal AK, Azizi AT, et al. Haglund’s syndrome: a commonly seen mysterious condition. Cureus, 2016, 8(10): e820.
28.	Maffulli N, Kenward MG, Testa V, et al. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med, 2003, 13(1): 11-15.
29.	Barg A, Ludwig T. Surgical strategies for the treatment of insertional Achilles tendinopathy. Foot Ankle Clin, 2019, 24(3): 533-559.
30.	Escriche-Escuder A, Casaña J, Cuesta-Vargas AI. Progression criteria in loading exercise programmes in lower limb tendinopathy: a protocol for a systematic review and meta-analysis. BMJ Open, 2019, 9(12): e032940.
31.	Alfredson H, Pietilä T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med, 1998, 26(3): 360-366.
32.	Lowdon A, Bader DL, Mowat AG. The effect of heel pads on the treatment of Achilles tendinitis: a double blind trial. Am J Sports Med, 1984, 12(6): 431-435.
33.	Zhang SR, Li H, Yao W, et al. Therapeutic response of extracorporeal shock wave therapy for insertional Achilles tendinopathy between sports-active and nonsports-active patients with 5-year follow-up. Orthop J Sports Med, 2020, 8(1): 2325967119898118.
34.	Stania M, Juras G, Chmielewska D, et al. Extracorporeal shock wave therapy for Achilles tendinopathy. Biomed Res Int, 2019, 2019: 3086910.
35.	Akoh CC, Phisitkul P. Minimally invasive and endoscopic approach for the treatment of noninsertional Achilles tendinopathy. Foot Ankle Clin, 2019, 24(3): 495-504.
36.	DeCarbo WT, Bullock MJ. Midsubstance tendinopathy, surgical management. Clin Podiatr Med Surg, 2017, 34(2): 175-193.
37.	Kolodziej P, Glisson RR, Nunley JA. Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund’s deformity: a biomechanical study. Foot Ankle Int, 1999, 20(7): 433-437.
38.	Nunley JA, Ruskin G, Horst F. Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy. Foot Ankle Int, 2011, 32(9): 850-855.
39.	白骏, 胡杏珍, 夏文平, 等. 跟腱末端病的影像特征及与术式选择相关性研究. 临床放射学杂志, 2019, 38(11): 2148-2152.
40.	Zadek I. An operation for the cure of achillobursitis. Am J Surg, 1939, 43(2): 542-546.
41.	Vernois J, Redfern D, Ferraz L, et al. Minimally invasive surgery osteotomy of the hindfoot. Clin Podiatr Med Surg, 2015, 32(3): 419-434.
42.	Pimprikar MV, Geddam M, Patii HG. Endoscopic calcaneoplasty for Haglunds excision using two lateral portals. Journal of Orthopaedic Case Reports, 2017, 7(6): 46-49.

1. Mahan J, Damodar D, Trapana E, et al. Achilles tendon complex: The anatomy of its insertional footprint on the calcaneus and clinical implications. J Orthop, 2020, 17: 221-227.
2. Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Med Arthrosc Rev, 2009, 17(2): 112-126.
3. Syed TA, Perera A. A proposed staging classification for minimally invasive management of Haglund’s syndrome with percutaneous and endoscopic surgery. Foot & Ankle Clinics, 2016, 21(3): 641-664.
4. Jennings MM, Liew V, Marine B. Updates in tendinopathy treatment options. Clin Podiatr Med Surg, 2019, 36(4): 543-552.
5. 李宏云, 徐翰林, 白露, 等. 跟腱止点性腱病临床治疗专家共识. 中国运动医学杂志, 2019, 38(10): 829-833.
6. Ballal MS, Walker CR, Molloy AP. The anatomical footprint of the Achilles tendon: a cadaveric study. Bone Joint J, 2014, 96-B(10): 1344-1348.
7. Jones FW, Peltier LF. Structure and function as seen in the foot. Clin Orthop Relat Res, 2001, (391): 3-6.
8. Edama M, Masayoshi K, Onishi H, et al. Structure of the Achilles tendon at the insertion on the calcaneal tuberosity. J Anat, 2016, 229(5): 610-614.
9. Maffulli N, Longo GU, Kadakia A, et al. Achilles tendinopathy. Foot Ankle Surg, 2019. https://doi.org/10.1016/j.fas.2019.03.009.
10. Kvist M. Achilles tendon injuries in athletes. Sports Med, 1994, 18(3): 173-201.
11. Myerson MS, McGarvey W. Disorders of the Achilles tendon insertion and Achilles tendinitis. Instr Course Lect, 1999, 48(3): 211-218.
12. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med, 1976, 4(4): 145-150.
13. Kokubu S, Inaki R, Hoshi K, et al. Adipose-derived stem cells improve tendon repair and prevent ectopic ossification in tendinopathy by inhibiting inflammation and inducing neovascularization in the early stage of tendon healing. Regen Ther, 2020, 14: 103-110.
14. Singh A, Calafi A, Diefenbach C, et al. Noninsertional tendinopathy of the Achilles. Foot Ankle Clin, 2017, 22(4): 745-760.
15. Clain MR, Baxter DE. Achilles tendinitis. Foot Ankle, 1992, 13(8): 482-487.
16. Feilmeier M. Noninsertional Achilles tendinopathy pathologic background and clinical examination. Clin Podiatr Med Surg, 2017, 34(2): 129-136.
17. Eickler R, Pomeranz SJ. Achilles tendinitis. J Surg Orthop Adv, 2015, 24(3): 198-202.
18. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy, 1998, 14(8): 840-843.
19. Pfeffer G, Gonzalez T, Zapf M, et al. Achilles pullout strength after open calcaneoplasty for Haglund’s syndrome. Foot Ankle Int, 2018, 39(8): 966-969.
20. Jerosch J, Schunck J, Sokkar SH. Endoscopic calcaneoplasty (ECP) as a surgical treatment of Haglund’s syndrome. Knee Surg Sports Traumatol Arthrosc, 2007, 15(7): 927-934.
21. Kang S, Thordarson DB, Charlton TP. Insertional Achilles tendinitis and Haglund’s deformity. Foot Ankle Int, 2012, 33(6): 487-491.
22. 桂鉴超, 顾湘杰, 王旭, 等. 跟腱末端病的诊断及手术治疗. 中华骨科杂志, 2007, 27(6): 413-416.
23. Fowler A, Philip JF. Abnormality of the calcaneus as a cause of painful heel its diagnosis and operative treatment. Br J Surg, 2005, 32(128): 494-498.
24. Pavlov H, Heneghan MA, Hersh A, et al. The Haglund syndrome: initial and differential diagnosis. Radiology, 1982, 144(1): 83-88.
25. Wezenbeek E, Mahieu N, Willems TM, et al. What does normal tendon structure look like? New insights into tissue characterization in the Achilles tendon. Scand J Med Sci Sports, 2017, 27(7): 746-753.
26. Abate M, Schiavone C, Salini V, et al. Occurrence of tendon pathologies in metabolic disorders. Rheumatology (Oxford), 2013, 52(4): 599-608.
27. Vaishya R, Agarwal AK, Azizi AT, et al. Haglund’s syndrome: a commonly seen mysterious condition. Cureus, 2016, 8(10): e820.
28. Maffulli N, Kenward MG, Testa V, et al. Clinical diagnosis of Achilles tendinopathy with tendinosis. Clin J Sport Med, 2003, 13(1): 11-15.
29. Barg A, Ludwig T. Surgical strategies for the treatment of insertional Achilles tendinopathy. Foot Ankle Clin, 2019, 24(3): 533-559.
30. Escriche-Escuder A, Casaña J, Cuesta-Vargas AI. Progression criteria in loading exercise programmes in lower limb tendinopathy: a protocol for a systematic review and meta-analysis. BMJ Open, 2019, 9(12): e032940.
31. Alfredson H, Pietilä T, Jonsson P, et al. Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis. Am J Sports Med, 1998, 26(3): 360-366.
32. Lowdon A, Bader DL, Mowat AG. The effect of heel pads on the treatment of Achilles tendinitis: a double blind trial. Am J Sports Med, 1984, 12(6): 431-435.
33. Zhang SR, Li H, Yao W, et al. Therapeutic response of extracorporeal shock wave therapy for insertional Achilles tendinopathy between sports-active and nonsports-active patients with 5-year follow-up. Orthop J Sports Med, 2020, 8(1): 2325967119898118.
34. Stania M, Juras G, Chmielewska D, et al. Extracorporeal shock wave therapy for Achilles tendinopathy. Biomed Res Int, 2019, 2019: 3086910.
35. Akoh CC, Phisitkul P. Minimally invasive and endoscopic approach for the treatment of noninsertional Achilles tendinopathy. Foot Ankle Clin, 2019, 24(3): 495-504.
36. DeCarbo WT, Bullock MJ. Midsubstance tendinopathy, surgical management. Clin Podiatr Med Surg, 2017, 34(2): 175-193.
37. Kolodziej P, Glisson RR, Nunley JA. Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and Haglund’s deformity: a biomechanical study. Foot Ankle Int, 1999, 20(7): 433-437.
38. Nunley JA, Ruskin G, Horst F. Long-term clinical outcomes following the central incision technique for insertional Achilles tendinopathy. Foot Ankle Int, 2011, 32(9): 850-855.
39. 白骏, 胡杏珍, 夏文平, 等. 跟腱末端病的影像特征及与术式选择相关性研究. 临床放射学杂志, 2019, 38(11): 2148-2152.
40. Zadek I. An operation for the cure of achillobursitis. Am J Surg, 1939, 43(2): 542-546.
41. Vernois J, Redfern D, Ferraz L, et al. Minimally invasive surgery osteotomy of the hindfoot. Clin Podiatr Med Surg, 2015, 32(3): 419-434.
42. Pimprikar MV, Geddam M, Patii HG. Endoscopic calcaneoplasty for Haglunds excision using two lateral portals. Journal of Orthopaedic Case Reports, 2017, 7(6): 46-49.

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