Achilles Tendonitis / Tendinopathy
Mr Welck Algorithm
- 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.
- Imaging is not required for diagnosis or referral.
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.
- Diagnostic uncertainty.
- Failure of conservative measures after a minimum of 3 months.
- Results of diagnostics indicate specialist assessment required.