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http://dx.doi.org/10.14193/jkfas.2021.25.2.61

Etiology of Achilles Tendinopathy: Inflammation versus Overuse  

Kim, Dae-Yoo (Department of Orthopedic Surgery, Inje University Busan Paik Hospital)
Lee, Dong Yeon (Department of Orthopedic Surgery, Seoul National University Hospital)
Publication Information
Journal of Korean Foot and Ankle Society / v.25, no.2, 2021 , pp. 61-65 More about this Journal
Abstract
It is widely acknowledged that Achilles tendinopathy and resultant degeneration of the Achilles tendon could be either due to vigorous physical exertion or due to inflammation of the tendon associated with systemic disease. The overuse injuries are generally multifactorial in origin and are caused by repetitive strain of the affected tendon till the tendon can no longer endure the tensile stress. Various alignment and biomechanical faults are claimed to play a causative role. Only 2% of patients complaining of Achilles tendon pain are caused by systemic disease. However, to ensure the right approach to treatment, it is necessary to rule out inflammatory tendinitis caused by systemic diseases such as rheumatoid arthritis, gout, and seronegative spondyloarthrosis.
Keywords
Achilles tendinitis; Achilles tendinopathy; Overuse induced tendinopathy; Systemic disease-induced tendinopathy;
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1 Falsetti P, Frediani B, Fioravanti A, Acciai C, Baldi F, Filippou G, et al. Sonographic study of calcaneal entheses in erosive osteoarthritis, nodal osteoarthritis, rheumatoid arthritis and psoriatic arthritis. Scand J Rheumatol. 2003;32:229-34. doi: 10.1080/03009740310003721.   DOI
2 Suzuki T, Ishihara K. Achilles paratendonitis as the initial manifestation of rheumatoid arthritis. Mod Rheumatol. 2011;21:219-22. doi: 10.1007/s10165-010-0369-4.   DOI
3 Andia I, Abate M. Hyperuricemia in tendons. Adv Exp Med Biol. 2016;920:123-32. doi: 10.1007/978-3-319-33943-6_11.   DOI
4 Arnett FC. The seronegative spondyloarthropathies. Curr Opin Rheumatol. 1992;4:460-2.
5 Kehl AS, Corr M, Weisman MH. Review: enthesitis: new insights into pathogenesis, diagnostic modalities, and treatment. Arthritis Rheumatol. 2016;68:312-22. doi: 10.1002/art.39458.   DOI
6 Hess GP, Cappiello WL, Poole RM, Hunter SC. Prevention and treatment of overuse tendon injuries. Sports Med. 1989;8:371-84. doi: 10.2165/00007256-198908060-00005.   DOI
7 Kirchgesner T, Larbi A, Omoumi P, Malghem J, Zamali N, Manelfe J, et al. Drug-induced tendinopathy: from physiology to clinical applications. Joint Bone Spine. 2014;81:485-92. doi: 10.1016/j.jbspin.2014.03.022.   DOI
8 Bywaters EG. Heel lesions of rheumatoid arthritis. Ann Rheum Dis. 1954;13:42-51. doi: 10.1136/ard.13.1.42.   DOI
9 Genc H, Cakit BD, Tuncbilek I, Erdem HR. Ultrasonographic evaluation of tendons and enthesal sites in rheumatoid arthritis: comparison with ankylosing spondylitis and healthy subjects. Clin Rheumatol. 2005;24:272-7. doi: 10.1007/s10067-004-0997-1.   DOI
10 Stiskal M, Szolar DH, Stenzel I, Steiner E, Mesaric P, Czembirek H, et al. Magnetic resonance imaging of Achilles tendon in patients with rheumatoid arthritis. Invest Radiol. 1997;32:602-8. doi: 10.1097/00004424-199710000-00004.   DOI
11 Fritz J, Henes JC, Fuld MK, Fishman EK, Horger MS. Dual-energy computed tomography of the knee, ankle, and foot: noninvasive diagnosis of gout and quantification of monosodium urate in tendons and ligaments. Semin Musculoskelet Radiol. 2016;20:130-6. doi: 10.1055/s-0036-1579709.   DOI
12 Logan JA, Morrison E, McGill PE. Serum uric acid in acute gout. Ann Rheum Dis. 1997;56:696-7. doi: 10.1136/ard.56.11.696a.   DOI
13 Pineda C, Amezcua-Guerra LM, Solano C, Rodriguez-Henriquez P, Hernandez-Diaz C, Vargas A, et al. Joint and tendon subclinical involvement suggestive of gouty arthritis in asymptomatic hyperuricemia: an ultrasound controlled study. Arthritis Res Ther. 2011;13:R4. doi: 10.1186/ar3223.   DOI
14 Brandt J, Haibel H, Cornely D, Golder W, Gonzalez J, Reddig J, et al. Successful treatment of active ankylosing spondylitis with the anti-tumor necrosis factor alpha monoclonal antibody infliximab. Arthritis Rheum. 2000;43:1346-52. doi: 10.1002/1529-0131(200006)43:6<1346::AID-ANR18>3.0.CO;2-E.   DOI
15 Rubin G, Witten M. Plantar calcaneal spurs. Am J Orthop. 1963;5:38-41.
16 Amor B, Dougados M, Mijiyawa M. [Criteria of the classification of spondylarthropathies]. Rev Rhum Mal Osteoartic. 1990;57:85-9. French.
17 Becker MA, Schumacher HR Jr, Wortmann RL, MacDonald PA, Eustace D, Palo WA, et al. Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N Engl J Med. 2005;353:2450-61. doi: 10.1056/NEJMoa050373.   DOI
18 Jozsa LG, Kannus P. Human tendons: anatomy, physiology, and pathology. Champaign: Human Kinetics; 1997.
19 Astrom M. On the nature and etiology of chronic achilles tendinopathy [Thesis]. Lund: Lund University; 1997.
20 Kuo CF, Grainge MJ, Zhang W, Doherty M. Global epidemiology of gout: prevalence, incidence and risk factors. Nat Rev Rheumatol. 2015;11:649-62. doi: 10.1038/nrrheum.2015.91.   DOI
21 Kannus P. Etiology and pathophysiology of chronic tendon disorders in sports. Scand J Med Sci Sports. 1997;7:78-85. doi: 10.1111/j.1600-0838.1997.tb00123.x.   DOI
22 Dalbeth N, Kalluru R, Aati O, Horne A, Doyle AJ, McQueen FM. Tendon involvement in the feet of patients with gout: a dual-energy CT study. Ann Rheum Dis. 2013;72:1545-8. doi: 10.1136/annrheumdis-2012-202786.   DOI
23 Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med. 1976;4:145-50. doi: 10.1177/036354657600400404.   DOI
24 Khan KM, Cook JL, Bonar F, Harcourt P, Astrom M. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999;27:393-408. doi: 10.2165/00007256-199927060-00004.   DOI
25 Jozsa L, Reffy A, Kannus P, Demel S, Elek E. Pathological alterations in human tendons. Arch Orthop Trauma Surg. 1990;110:15-21. doi: 10.1007/BF00431359.   DOI
26 Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol. 1991;80:188-201.
27 Soma CA, Mandelbaum BR. Achilles tendon disorders. Clin Sports Med. 1994;13:811-23. doi: 10.1016/S0278-5919(20)30287-8.   DOI
28 Maffulli N, Wong J, Almekinders LC. Types and epidemiology of tendinopathy. Clin Sports Med. 2003;22:675-92. doi: 10.1016/s0278-5919(03)00004-8.   DOI
29 Laforgia R, Capocasale N, Saracino N, Sorarino M. [A clinical and ultrasonographic study of jumper's knee and the Achilles tendon in volleyball players]. J Sports Traumatol Relat Res. 1992;14:127-38. Italian.
30 Boyer GS, Templin DW, Bowler A, Lawrence RC, Everett DF, Heyse SP, et al. A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a communitywide epidemiologic study. Has the classic case misled us? Arch Intern Med. 1997;157:2111-7. doi: 10.1001/archinte.1997.00440390111014.   DOI
31 Pascual E, Addadi L, Andres M, Sivera F. Mechanisms of crystal formation in gout-a structural approach. Nat Rev Rheumatol. 2015;11:725-30. doi: 10.1038/nrrheum.2015.125.   DOI
32 Murtaugh B, Ihm JM. Eccentric training for the treatment of tendinopathies. Curr Sports Med Rep. 2013;12:175-82. doi: 10.1249/JSR.0b013e3182933761.   DOI
33 Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000;29:135-46. doi: 10.2165/00007256-200029020-00005.   DOI
34 Renstrom PKP. Prevention of sports injuries. 2nd ed. Philadelphia: WB Saunders; 1991.
35 Williams JG. Achilles tendon lesions in sport. Sports Med. 1986;3:114-35. doi: 10.2165/00007256-198603020-00003.   DOI
36 Smolen JS, Schols M, Braun J, Dougados M, FitzGerald O, Gladman DD, et al. Treating axial spondyloarthritis and peripheral spondyloarthritis, especially psoriatic arthritis, to target: 2017 update of recommendations by an international task force. Ann Rheum Dis. 2018;77:3-17. doi: 10.1136/annrheumdis-2017-211734.   DOI