Epidemiology | Achilles tendonitis


Achilles tendonitis occurs particularly frequently in people who do more sports or are even competitive athletes. In this context, runners in particular suffer

  • About 9% of all competitive athletes suffer from Achilles tendonitis. – In the general population one person in 10000 has this disease (1/10000).

In general, the complaints first occur at the beginning or end of training or sporting activity, during which time patients often experience pain relief. With further strain the pain increases more and more until it is impossible to move or do sports without pain. The symptoms also differ between acute and chronic Achilles tendonitis.

With an acute Achilles tendon inflammation there is a gradually increasing pain in the Achilles tendon directly above the heel. This process usually lasts for a few days and the pain becomes increasingly severe. The pain can be temporarily relieved by resting.

During the manual examination of the Achilles tendon, it can be seen that it has hardened as a sign of acute Achilles tendonitis. The chronic Achilles tendonitis often follows an acute Achilles tendonitis. With chronic Achilles tendonitis, the pain occurs over weeks or months.

The pain remains about the same intensity with every type of movement or sporting activity, but is particularly strong when running uphill or climbing stairs. After resting or in the morning, the pain is particularly strong because the Achilles tendon stiffens slightly and is not elastic enough to perform the movements without pain when the strain is reapplied. Sometimes small nodules are found during the palpation, especially at a distance of 2-4 cm from the base of the Achilles tendon on the heel bone.

Often the Achilles tendon is swollen and thickened and a slight redness of the skin over the Achilles tendon can be seen. Rarely you can also hear a slight cracking sound when you press on the Achilles tendon with your finger while moving your ankle. Not all criteria need to be fulfilled to be able to speak of an Achilles tendon inflammation. For example, reddening of the skin occurs rather rarely.

Duration of Achilles tendonitis

The duration of an Achilles tendonitis depends on the severity of the disease. In addition, there are basically two different types, acute and chronic Achilles tendonitis. The acute inflammation, which occurred suddenly, can be healed after one to two weeks if the tendon is spared and possibly with further measures such as physiotherapy.

If the inflammation has become more severe or chronic, prolonged conservative therapy or surgery is often necessary. After this, the affected leg is immobilised in a splint for one to two months, followed by a rehabilitation phase of about three months. During this period, the tendon must be protected and must not be subjected to high loads.

The Achilles tendon inflammation is an overuse injury. It often occurs when the load is increased significantly in a short period of time and the Achilles tendon is thus exposed to unknown high loads. In running, this disease is particularly common and results from overloading, which is caused by When running uphill, the Achilles tendon is additionally stretched strongly with every step, which does not cause any problems for a certain time, but the Achilles tendon can tire more quickly in the future due to the additional strain.

In addition to the terrain, the training surface is also a possible cause of Achilles tendon inflammation. – too many training kilometers,

  • Too fast running speed or
  • Particularly hilly terrain are favoured. For example, if you change from forest roads to asphalt, you may experience more discomfort afterwards.

In addition to increased training activity, shortening the breaks in between can also lead to increased pain. In addition to the training conditions, footwear should not be neglected as a possible cause of Achilles tendon injuries. Especially when women wear very long shoes with high heels, the Achilles tendon can be shortened because shoes with high heels compress the Achilles tendon.

When changing to normal footwear, problems often occur because the Achilles tendon is overstretched to ensure normal walking. Age also plays a role in the development of Achilles tendon inflammation. People over 35 years of age are particularly susceptible.

Adolescents and young adults, on the other hand, very rarely have problems with it, even under heavy strain. Anatomically speaking, calf muscles that are too weak or too short (gastrocnemius and soleus) as well as an ankle joint with limited mobility can lead to Achilles tendon problems. Malpositioning of the foot as a result of a clubfoot or pointed foot can also lead to Achilles tendon problems.

However, this malalignment is often treated conservatively right after birth and is usually without consequential damage. The Achilles tendon inflammation is an extremely typical disease of competitive athletes and among them especially of runners. Persons who like to go jogging for a long time are particularly often affected by Achilles tendonitis.

Therefore, these risk groups in particular should pay close attention to pain in the Achilles tendon and calf area and, if necessary, take care of the area to prevent its condition from worsening. Jogging is therefore a risk factor for the development of an Achilles tendon inflammation, since extreme loads are mainly conducted via the Achilles tendon during this sport and only then are they distributed over the body. With each step, the load during jogging is a multiple of the body weight.

It is therefore hardly surprising that a very large proportion of competitive athletes get Achilles tendonitis at least once in their career. The pes valgus foot is a pathological malposition of the foot. Here, the inner (medial) edge of the foot is lowered, while the outer (lateral) edge of the foot is raised.

The pes valgus foot is more often found in combination with a flat foot and knock-knees. From a medical point of view, the pigeon-toed foot is a problem, especially with high loads such as those frequently encountered in sports. Due to the unnatural position of the foot, the strain on the Achilles tendon is significantly increased compared to a healthy foot position. Especially in connection with flat feet, the mechanical forces on the Achilles tendon increase because the natural rolling function is eliminated.