In this type of Achilles tendinosis, the tendon fibres at the middle segment between heel bone and muscle belly gets swelled up and degenerated due to accumulation of microtrauma. This generally affects young, active people involved in sports activity. It also affects middle aged to older people with DM.

Factors that influence accumulation of microinjury to the tendon and progression to tendinosis are :
*. Overuse in runner
*. Inappropriate training method
*. Activities involved sudden acceleration and deacceleration while running
*. Training on hard or sloppy surface

In older people tendon degeneration is more common in person with DM, high blood cholesterol level and HTN. Inflammatory arthritis like ankylosis spondylitis, psoriatic arthritis, ingestion of antibiotic like ciprofloxacin also contributes to tendon degeneration.

One feels pain and stiffness along the tendon and back of the ankle joint. There may be swelling also at the prominence of tendon just above the heel bone. Pain Increases after activity and at the end of the day. For athletes it’s become difficult to start the activity but eases off after warm up and again sores after day long practice. Performance level can also affect in professional athletes.

This can led to rupture of tendon if neglected which is a severe consequence and this can be prevented. So whenever an athlete experience these symptoms should visit a Foot & Ankle Specialist for proper evaluation.

Most of the time the history and symptomatic presentation is enough to suspect the condition. Your specialist may ask you regarding your practice routine and technique, your medication history, your medical record and examine your ankle for movement, tenderness, muscle stiffness and local swelling. He may advice you for either USG or MRI to quantify the status of tendon and treatment planning. X-ray is not conclusive but may require as a routine to rule out other conditions.

Selfcare and prevention: In initial stages of the disease icing, rest, modification of activity and eccentric loading of Achilles Tendon can be helpful.

Your doctor may advice analgesic, icing, activity restriction to relieve acute pain. Modification of sports activity and training protocol along with physical therapy is the key for recovery and prevention from the deadly consequence to happen. Most effective exercise for this condition is eccentric loading of Achilles Tendon.

In recalcitrant cases different treatment modalities are practiced with variable success. PRP therapy, ablation therapy, dry needling and tendinoscopy are being done.  

In very advance stage where tendon degeneration is significant and is at risk of rupture, surgical excision and reconstruction of the tendon with Flexor Hallucis Longus Tendon transfer may require.