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Practice Essentials

Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that
tendonitis is a misleading term that should no longer be used, because signs of true inflammation are
almost never present on histologic examination. Instead, the following histopathologically determined
nomenclature has evolved:

Paratenonitis: Characterized by paratenon inflammation and thickening, as well as fibrin adhesions [1]

Tendinosis: Characterized by intrasubstance disarray and degeneration of the tendon [2, 1, 3]

Tendon rupture

Patients with an Achilles tendon rupture frequently present with complaints of a sudden snap in the
lower calf associated with acute, severe pain. The patient reports feeling like he or she has been shot,
kicked, or cut in the back of the leg, which may result in an inability to ambulate further. A patient with
Achilles tendon rupture will be unable to stand on his or her toes on the affected side.

Tendinosis

Tendinosis is often pain free. Typically, the only sign of the condition may be a palpable intratendinous
nodule that accompanies the tendon as the ankle is placed through its range of motion (ROM).

Paratenonitis

Patients with paratenonitis typically present with warmth, swelling, and diffuse tenderness localized 2-6
cm proximal to the tendon's insertion.

Paratenonitis with tendinosis

This is diagnosed in patients with activity-related pain, as well as swelling of the tendon sheath and
tendon nodularity.