Achilles Tendonitis / Tendinopathy

Patient Information

Mr Welck Algorithm

http://www.patient.co.uk/pdf/12495.pdf

https://www.bofas.org.uk/Patient-Information/Achilles-Tendon

GP Information

Background Information

• A collection of problems including non insertional tendonitis, insertional tendonitis, retrocalcaneal bursitis and haglund deformity.
• Patients typically complain of posterior heel pain / burning / stiffness, with a palpable lump or difficulty in shoe wear.
• Examination may reveal a firm proximal or distal achilles or calcaneal swelling, with mid or distal tendon tenderness on palpation – worse on passive dorsiflexion.

Investigation Guidelines

• Imaging is not required for diagnosis or referral.

Management Recommendations

Conservative measures include

• Rest. PRICE
• Analgesia (e.g NSAIDs)
• Self Physiotherapy focussing on eccentric training and gastrocnemius-soleus stretching
• Avoid steroid injections due to risk of tendon rupture
• Heel sleeves and pads.

Referral Indications

• Diagnostic uncertainty.
• Failure of conservative measures after a minimum of 3 months.
• Results of diagnostics indicate specialist assessment required.