Achilles Tendon Pain (Achillodynia)

Achillodynia – colloquially called Achilles tendon pain – (“dynie” = pain) is a disorder of the Achilles tendon (tendo calcaneus) or of the attachment of the Achilles tendon (Tuber calcanei) (synonyms: achilles tendinitis; pain syndrome of the Achilles tendon; pain in the region of the Achilles tendon; inflammation of the Achilles tendon; tendinosis of the Achilles tendon; tendopathy of the Achilles tendon; tendinopathy of the Achilles tendon; ICD-10-GM M76.6: tendinitis of the Achilles tendon), which is associated with (sometimes severe) pain.

The most common reason for the pain syndrome is many years of misuse or overuse due primarily to sports activities, which leads to damage in and on the Achilles tendon.

The Achilles tendon connects the triceps surae muscle (three-headed calf muscle) to the tuber calcanei (Achilles tendon insertion) at the heel bone. It is 10-12 cm long and has a diameter of 0.5-1 cm. The Achilles tendon is the strongest tendon in the body.

Achillodynia develops after about ten years of performance-oriented training. It is one of the most common sports injuries and belongs to the group of insertional tendopathies (as well as golfer’s elbow and tennis elbow). Track and field athletes in particular (78%; sprinters and jumpers (forefoot runners)), but also athletes in other running and jumping sports, are prone to Achillodynia. Not infrequently, the pain syndrome leads to the unwanted end of the athletic career. Among recreational athletes, long distance runners (heel runners) are most affected by achillodynia.

Achillodynia can be a symptom of many diseases (see under “Differential diagnoses”).

The following forms of achillodynia are distinguished:

  • Primary achillodynia – idiopathic (the cause is unknown).
    • Usually due to overuse during sports activities.
  • Secondary Achillodynia – there is an increase in stress on the Achilles tendon due to:
    • Anatomical conditions
    • Inflammation in the area of the gliding/bursae.
    • Previous fractures at the upper ankle joint (OSG) or in the area of the tibia (shin bone).
    • Calcifications
  • Pseudo-achillodynia – clinical pictures that originate in the area close to the Achilles.

Sex ratio: men are more often affected than women.

Frequency peak: In recreational athletes, the disease occurs predominantly around the 40th year of life, in competitive athletes around the 24. The average age of onset is 30 years. On average, athletes have been active for twelve years when the first symptoms appear. It usually takes two years from the onset of symptoms to diagnosis.

It is estimated that about 10% of all joggers suffer from achillodynia from time to time. In almost half of the cases, the pain syndrome occurs on both sides.

Taking into account the shape of the foot, Achillodynia is clustered as follows: Normal foot 23%, flat foot 34%, and high-ankle foot 42%.

Tendinopathies (non-inflammatory tendon disease) of the Achilles tendon account for approximately 20-25% of all Achilles tendon problems.

Course and prognosis: In the early stage of Achillodynia, the pain usually occurs only after prolonged unaccustomed exertion and subsides within a few days if the patient takes it easy. If the affected person ignores the pain and continues to exercise unperturbed, the disease progresses. The pain then already occurs during moderate exertion or directly afterwards. This leads to degenerative processes of the Achilles tendon and consequently to structural changes of the same. The affected person can ultimately suffer from pain even at rest.In about 70-80% of cases, conservative treatment is successful. However, the affected person must have a lot of patience. The healing period of achillodynia is between three and six months. In rare cases, surgery is required. Achillodynia can heal spontaneously.