Course Description:

AT is a common pathology, especially among athletes, but it may also occur in nonathletes with sedentary lifestyles. Insertional AT is characterized by posterior heel pain at the insertion of the Achilles tendon on the calcaneus. It can present as an acute tendinitis that becomes chronic. Noninsertional AT is usually a chronic condition at presentation, with pain and tenderness occurring proximal to the tendon insertion. Noninsertional AT is characterized by noninflammatory degeneration of the tendon, likely caused by repetitive mechanical overloading, and is the more common form of AT in athletes. It occurs especially in athletes who participate in running and jumping sports. Patients with noninsertional AT typically present with a history of chronic, activity-related heel cord pain; nagging ache that is at its worst during the first few steps after non-weight-bearing; and tenderness and thickening of the Achilles tendon proximal to insertion. Histological findings show a failed healing response that includes a noninflammatory collagen disorientation that weakens tendon fibers. Therapeutic approaches that have been found to be effective include low-level laser therapy (LLLT), eccentric exercise loading, and shockwave therapy (SWT).