Achilles Tendonitis / Tendinopathy

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Patient Information

Mr Welck Algorithm

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.
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