a.k.a. achilles tendinitis

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What is Achilles tendonitis?
Achilles tendonitis, also known as Achilles tendinitis, is inflammation of the Achilles tendon. The Achilles tendon connects your calf muscles to the back of your heel bone. It allows extension of your foot downward (plantar flexion), away from your body, which lets your heel lift off the ground as you move forward when walking. Every time you take a step you rely on your Achilles tendon.

Achilles tendinopathy is prevalent and potentially incapacitating in athletes involved in running sports. It is a degenerative, not an inflammatory, condition. Most patients respond to conservative measures if the condition is recognised early. Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.

Hi, I'm the webmaster at Bioenergetic Spectrum. I am using this page for research and notes on what also works for me. About six months ago I began experiencing achilles tendinitis when I woke up. I don't train as hard as most athletes. I figured that it must be atrophy from sitting in front of the computer too long. Although the pain subsides after I do regular calisthenics and taijiquan every morning, the condition continues when I wake up the next morning. I figure there may be some uric acid crystals, calcification or even arthritis involved since I am what most people might call middle aged. I am going to share some proven detox methods as well as warm up exercises for defeating pain and stiffness in this most important of tendons for people who like to walk, run, and jump.

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achilles tendonThe gastrocnemius muscle merges with the soleus to form the Achilles tendon in two different ways. In the more common type 1 junction, the two aponeuroses join 12 cm proximal to their calcaneal insertion. In type 2, the gastrocnemius aponeurosis inserts directly into the aponeurosis of the soleus. The Achilles tendon has a round upper part and is relatively flat in its distal 4 cm.10 The fibres of the Achilles tendon are not vertical, but spiral 90�. This arrangement increases the tendon elongation and helps the release during locomotion of the energy stored within the tendon.1,2

Unlike other tendons around the ankle, which have a synovialsheath, the Achilles tendon is enveloped by a paratenon, a membraneconsisting of two layers: a deeper layer surrounding and indirect contact with the epitenon, and a superficial layer, theperitenon,3,4 which is connected with the underlying layer through the mesotenon. The paratenon originates from the deep fascia of the leg, the fascia cruris, covering the tendon posteriorly. Recently an organised thickening of the paratenon has been described as the "watershed band," consisting of a thickened portion of the paratenon from the deep fascia of the posterior aspect of the leg to envelope the watershed region in the Achilles tendon.5

A microvascular perfusion study in the human Achilles tendonassessed by laser Doppler flowmetry showed that the blood flows considerably lower near the calcaneal insertion but otherwisewas distributed evenly in the tendon.6 Further, blood flow in the symptomatic Achilles tendinopathy was considerably elevated compared with the control tendons.7

Langberg et al8 measured blood flow in the peritendinous space of the human Achilles tendon at rest and after 40 minutes of dynamic contraction of the triceps surae. Blood flow in the peritendinous space 5 cm proximal to its insertion increased fourfold with exercise, while it increased only 2.5-fold when measured 2 cm proximal to the insertion.8 The increase in blood flow during exercise probably results from the considerable rise in the negative tissue pressure in the peritendinous space.9

lower leg including achilles tendon and calf muscles

Tenocytes and tenoblasts comprise 90 - 95% of the cellular elements of the tendon. Chondrocytes, vascular cells, synovial cells, and smooth muscle cells form the remaining cellular elements. The extracellular tendon matrix is composed of collagen and elastin fibres, ground substance such as proteoglycans, andorganic components such as calcium.10,11

Collagen fibrils are bundled into fascicles containing blood,lymphatic vessels, and nerves,12 and have been shown to interchange between fascicles.13 The fascicles, which are surrounded by the endotenon, group together to form the gross structure of the tendon. The tendon is enveloped by a well defined layer of connective tissue, the epitenon. This, in its turn, is surrounded by the paratenon, with a thin layer of fluid in between to reduce friction during tendon motion. The innermost layer of the epitenon is in direct contact with the endotenon.

Actin and myosin are present in tenocytes,14 and tendons have almost ideal mechanical properties for the transmission of force from muscle to bone. Tendons are stiff and resilient, with high tensile strength: they can stretch up to 4% before damage.10,15Achilles tendons in men have higher maximum rupture force and stiffness with a larger cross sectional area than in women, while younger tendons have significantly higher tensile rupture stress and lower stiffness.16

The peak Achilles tendon force and the mechanical work by the calf muscles is 2233 Newtons (N) and 34 Joules (J) in the squat jump, 1895 N and 27 J in the counter movement jump, and 3786 N and 51 J when hopping.17 The indirect estimation of peak load on the Achilles tendon, normalised to subject body weight, is 6.1 - 8.2 x body weight during running, with a tensile force of more than 3 kN.18

The loads imposed on the Achilles tendon were measured using a "buckle"-type transducer implanted in the Achilles tendon under local anaesthesia. They reached up to 9 kN during running, corresponding to 12.5 times the body weight, 2.6 kN during slow walking, and less than 1 kN during cycling.2, 19, 22

A tendon loses its wavy configuration when it is stretched more than 2%. As collagen fibres deform, they respond linearly to increasing tendon loads.10,23 The normal wavy appearance of the tendon is regained if the strain placed on it remains at less than 4%. At strain levels greater than 8%, macroscopic rupture will occur.15,24,25

What causes Achilles tendinitis?
Achilles tendinitis can be caused by:

  • overuse of the Achilles tendon;
  • overly tight calf muscles;
  • excessive running up hill or down hill;
  • a sudden increase in the amount of exercise, e.g. running for a longer distance;
  • wearing ill-fitting running shoes, such as those with soles that are too stiff; or
  • wearing high heels often and changing between high heels all day and flat shoes or low running shoes in the evening.

The causes of Achilles tendinopathy remain unclear.2,4 Various theories link tendinopathies to overuse stresses, poor vascularity, lack of flexibility, genetic make up, sex, and endocrine or metabolic factors

Excessive loading of the tendon during vigorous training activitiesis regarded as the main pathological stimulus.2,4,37 The Achilles tendon may respond to repetitive overload beyond physiological threshold by either inflammation of its sheath or degeneration of its body, or by a combination of the two.38 Damage to the tendon can occur even if it is stressed within its physiological limits when the frequent cumulative microtrauma applied do not leave enough time for repair.1 Microtrauma can result from non-uniform stress within the Achilles tendon from different individual force contributions of the gastrocnemius and soleus, producing abnormal load concentrations within the tendon and frictional forces between the fibrils, with localised fibre damage.39

Tendinopathy has been attributed to a variety of intrinsic andextrinsic factors. Tendon vascularity, gastrocnemius-soleusdysfunction, age, sex, body weight and height, pes cavus deformity,and lateral ankle instability are common intrinsic factors.Excessive motion of the hindfoot in the frontal plane, especiallya lateral heel strike with excessive compensatory pronation, is thought to cause a "whipping action" on the Achilles tendon, and predispose it to tendinopathy.40 Also, an appreciable forefoot varus has often been found in patients with Achilles tendon problems.41 Perhaps for these reasons foot orthoses are advocated to control symptoms in chronic Achilles tendinopathy,42 although the scientific evidence from randomised controlled trials for their use is still lacking. Changes in training pattern, poor technique, previous injuries, footwear, and environmental factors such as training on hard, slippery, or slanting surfaces are extrinsic factors that may predispose the athlete to Achilles tendinopathy (table 3Go).4,37,4345 It should be emphasised, however, that these are aetiopathogenetic theories, and a cause-effect relation has not been shown in longitudinal studies based on hypothesis testing.

History and examination play a key role in diagnosis and management of Achilles tendinopathy. The onset of pain, duration, and aggravating factors should be documented. Thorough enquiry should be made into the relation of pain to various activities, intensity of training, and exercise technique. Details of previous treatments are also important.

Achilles tendinopathy typically presents with pain 26 cm proximal to the tendon insertion after exercise. As the pathological process progresses, pain may occur during exercise, and, in severe cases, the pain interferes with activities of daily living.99 There is good correlation between the severity of the disease and the degree of morning stiffness. Runners experience pain at the beginning and end of a training session, with a period of diminished discomfort in between.100

Clinical examination should start by exposing both legs from above the knees, and the patient should be examined standing and prone. The foot and the heel should be inspected for any mal-alignment, deformity, obvious asymmetry in tendon size, localised thickening, Haglund heel, and any previous scars. The Achilles tendon should be palpated to detect tenderness, heat, thickening, nodularity, and crepitation.101 The tendon's excursion is assessed. The "painful arc" sign helps to distinguish between tendon and paratenon lesions. In paratendinopathy, the area of maximum thickening and tenderness remains fixed in relation to the malleoli from full dorsiflexion to plantar flexion, whereas lesions within the tendon move with ankle motion.88 Patients with more chronic tendinopathy may have greater difficulty in performing the test than patients who present more acutely,101 although we have not found this test helpful in clinical practice.

Overuse is common in walkers, runners, dancers and other athletes who do a lot of jumping and sudden starts/stops, which exert a lot of stress on the Achilles tendon.

Continuing to stress an inflamed Achilles tendon can cause rupture of the tendon � it snaps, often with a distinctive popping sound. A ruptured Achilles tendon makes it virtually impossible to walk. An Achilles tendon rupture is usually treated with surgical repair or wearing a cast.

Symptoms of Achilles tendinitis

  • Pain anywhere along the tendon, but most often on or close to the heel.
  • Swelling of the skin over the tendon, associated with warmth, redness and tenderness.
  • Pain on rising up on the toes and pain with pushing off on the toes.
  • A painful heel for the first few minutes of walking after waking up in the morning.
  • Range of motion of the ankle may be limited.

What you can do in the first 48 hours of an Achilles injury

  • Rest the affected foot and avoid weight-bearing activities.
  • Use ice packs to help ease the swelling, pain and redness.
  • Compress the affected foot and ankle with an elastic compression bandage.
  • Elevate the affected foot as much as possible while the inflammation settles.

If you cannot walk properly and think you may have ruptured the tendon, see a doctor straight away. Similarly, if you have a sudden feeling like you have been kicked or shot in the back of the leg, seek medical advice.

The commonest form of tendon healing is by scarring, which is inferior to healing by regeneration.20,53 A tendon heals in essentially the same way as soft tissue, going through the same inflammatory (17 days of injury), proliferative (721 days), and remodeling (three weeks to one year) phases. Despite collagen maturation and remodeling, tendons are biochemically and metabolically less active than bone and muscle.20,53 Fibroblasts synthesise collagen type III in the proliferative phase. This will be replaced gradually by collagen type I from day 1214 with progressive increase in tensile strength.20

In animals, by 15 days after surgery, the healing tendons regain 48% tensile strength, 30% of energy absorption, 20% tensile stress, and 14% Young's modulus of elasticity of intact tendons. Healing tendons have 80% of the collagen and 60% of the collagen cross links (hydroxypyridinium) of normal tendons. Healing tendons yield more soluble collagen than intact tendons. This has led to the hypothesis that increased collagen synthesis takes place, possibly with enhanced resorption of mature collagen in healing tendons compared with intact tendons. Electron microscopy shows ultrastructural differences between intact and healing tendons.60

Recovery from tendon injury is slow because of many factorsincluding low oxygen consumption, slow synthesis of structural protein, and excessive load. The oxygen consumption of tendons is 7.5 times lower than that of skeletal muscles, and tendons are able to sustain loads of up to 17 times body weight.61 Recent studies have shown that the healing capacity of tendons may have been underestimated.62

Rehabilitation for Achilles tendinitis
See your doctor or sports therapist for further advice. You may be prescribed anti-inflammatory medication and a rehabilitation programme. Sometimes, the ankle may be put in a cast to immobilise the injury.

  • Gentle calf stretching is the first stage of rehabilitation. Don't stretch to the point of pain.
  • Strengthening the Achilles tendon is the second stage. Your doctor or sports therapist will be able to advise you on exercises for this.
  • As symptoms resolve, resume normal weight-bearing activities gradually.
  • Avoid running until all tenderness has gone. Swimming or cycling in low gear are good replacement activities.

Preventing Achilles tendinitis

  • Do strengthening and stretching exercises to keep calf muscles strong and flexible.
  • Keep your hamstring muscles flexible by stretching.
  • Warm up and stretch adequately before participating in any sports.
  • Always increase the intensity and duration of training gradually.
  • Do not continue an exercise if you experience pain in the tendon.
  • Wear properly fitted running and other sports shoes, including properly fitted arch supports if your feet roll inwards excessively (over-pronate).

When to see a doctor
Consult a doctor if you feel pain over your heels that worsens with exercise.

Many clinical and biological aspects of Achilles tendinopathy are still unclear. It is classically considered an overuse injury. Nevertheless, some patients seem to be more prone to it than others despite similar training and competition loads.

Although Achilles tendinopathy has been extensively studied, there is a clear lack of properly conducted scientific research to clarify its causes, pathology, and optimal management plan.

The outcome of Achilles tendinopathy is more favourable when treated within six months of onset. Most patients respond to conservative measures if the condition is recognised early, whereas continuing the offending activities leads to adhesion and chronic changes which are more resistant to conservative treatment. Teaching patients to control the symptoms may be more beneficial than leading them to believe that Achilles tendinopathy is fully curable. Progressive eccentric training has been reported with encouraging short term results.

Surgery usually involves removal of adhesions and degenerated areas and decompression of the tendon by tenotomy or measures that influence the local circulation.

It is still debatable why tendinopathic tendons respond to surgery.58 For example, we do not know whether surgery induces revascularisation, denervation, or both, resulting in pain reduction. It is also unclear how longitudinal tenotomy improves vascularisation.

As the biology of tendinopathy is being clarified, more effective management regimens may come to light, improving the success rate of both conservative and operative management.

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  1. Alexander RM, Bennet-Clark HC. Storage of elastic strain energy in muscle and other tissues. Nature 1977;265:114�17.
  2. Movin T. Aspects of aetiology, pathoanatomy and diagnostic methods in chronic mid-portion achillodynia. PhD thesis, Karolinska Institutet, 1998:1�64.
  3. Kvist H, Kvist M. The operative treatment of chronic calcaneal paratenonitis. J Bone Joint Surg [Br] 1980;62:353�7.
  4. Maffulli N, Benazzo F. Basic science of tendons. Sports Medicine Arthroscopy Review 2000;8:1�5.
  5. Saxena A, Bareither D. Magnetic resonance and cadaveric findings of the "watershed band" of the achilles tendon. J Foot Ankle Surg 2001;40:132�6.
  6. Astrom M, Westlin N. Blood flow in chronic Achilles tendinopathy. Clin Orthop 1994;308:166�72.
  7. Astrom M, Westlin N. Blood flow in the human Achilles tendon assessed by laser Doppler flowmetry. J Orthop Res 1994;12:246�52.
  8. Langberg H, Bulow J, Kjaer M. Blood flow in the peritendinous space of the human Achilles tendon during exercise. Acta Physiol Scand 1998;163:149�53.
  9. Langberg H, Skovgaard D, Bulow J, et al. Negative interstitial pressure in the peritendinous region during exercise. J Appl Physiol 1999;87:999�1002.
  10. Jozsa L, Kannus P. Human tendon: anatomy, physiology and pathology. Champaign: Human Kinetics, 1997.
  11. Maffulli N. Rupture of the Achilles tendon. J Bone Joint Surg [Am] 1999;81:1019�36.[
  12. Ross MH, Romrell LJ. Connective tissue. In: Histology: a text and atlas, 2nd ed. Baltimore: Williams and Wilkins, 1989.
  13. Arndt AN, Notermans H-P, KoebkeJ, et al. Zur Fasertextur der menschlichen Achillessehne: Eine Analyse durch Mazeration. Der Preparator 1997;43:67�70.
  14. Ippolito E, Natali PG, Postacchini F, et al. Morphological, immunochemical, and biochemical study of rabbit achilles tendon at various ages. J Bone Joint Surg [Am] 1980;62:583�98.
  15. Ker RF. Dynamic tensile properties of the plantaris tendon of sheep (Ovis aries). J Exp Biol 1981;93:283�302.[Abstract]
  16. Thermann H, Frerichs O, Biewener A, et al. Biomechanical studies of human Achilles tendon rupture. Unfallchirurg 1995;98:570�5.
  17. Fukashiro S, Komi PV, Jarvinen M, et al. In vivo Achilles tendon loading during jumping in humans. Eur J Appl Physiol 1995;71:453�8.
  18. Scott SH, Winter DA. Internal forces of chronic running injury sites. Med Sci Sports Exerc 1990;22:357�69.
  19. Gregor RJ, Komi PV, Jarvinen M. Achilles tendon forces during cycling. Int J Sports Med 1987;8(suppl 1):9�14.
  20. Komi PV. Relevance of in vivo force measurements to human biomechanics. J Biomech 1990;23(suppl 1):23�34.
  21. Komi PV, Fukashiro S, Jarvinen, M. Biomechanical loading of Achilles tendon during normal locomotion. Clin Sports Med 1992;11:521�31.
  22. Komi PV, Salonen M, Jarvinen M, et al. In vivo registration of Achilles tendon forces in man. I. Methodological development. Int J Sports Med 1987;8(suppl 1):3�8.
  23. Aspden RM, Bornstein NH, Hukins DW. Collagen organisation in the interspinous ligament and its relationship to tissue function. J Anat 1987;155:141�51.
  24. O'Brien M. Functional anatomy and physiology of tendons. Clin Sports Med 1992;11:505�20.
  25. Whittaker P, Canham PB. Demonstration of quantitative fabric analysis of tendon collagen using two-dimensional polarized light microscopy. Matrix 1991;11:56�62.
  26. Khan KM, Maffulli N. Tendinopathy: an Achilles' heel for athletes and clinicians. Clin J Sport Med 1998;8:151�4.
  27. James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med 1978;6:40�50.
  28. Benazzo F, Maffulli N. An operative approach to Achilles tendinopathy. Sports Medicine Arthroscopy Review 2000;8:96�101.
  29. Arndt AN, Komi PV, Bruggemann GP, et al. Individual muscle contributions to the in vivo achilles tendon force. Clin Biomech 1998;13:532�41.
  30. James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med 1978;6:40�50.
  31. Kvist M. Achilles tendon injuries in athletes. Sports Med 1994;18:173�201.
  32. Bates BT, Osternig LR, Mason B, et al. Foot orthotic devices to modify selected aspects of lower extremity mechanics. Am J Sports Med 1979;7:338�42.
  33. Binfield PM, Maffulli N. Surgical management of common tendinopathies of the lower limb.Sports Exercise Injuries 1997;3:116�22.
  34. Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol 1991;80:188�201.
  35. Subotnick SI, Sisney P. Treatment of Achilles tendinopathy in the athlete. J Am Podiatr Med Assoc 1986;76:552�7.
  36. Tallon C, Maffulli N, Ewen SWB. Ruptured Achilles tendons are significantly more degenerated than tendinopathic tendons. Med Sci Sports Exerc 2001;33:1983�90.
  37. Ireland D, Harrall R, Curry V, et al. Multiple changes in gene expression in chronic human Achilles tendinopathy. Matrix Biol 2001;20:159�69.
  38. Alfredson H, Thorsen K, Lorentzon R. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic achilles tendon pain. Knee Surg Sports Traumatol Arthrosc 1999;7:378�81.
  39. Alfredson H, Forsgren S, Thorsen K, et al. Glutamate NMDAR1 receptors localised to nerves in human Achilles tendons. Implications for treatment? Knee Surg Sports Traumatol Arthrosc 2001;9:123�6.
  40. Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med 1976;4:145�50.
  41. Maffulli N, Khan KM, Puddu G. Overuse tendon conditions: time to change a confusing terminology. Arthroscopy 1998;14:840�3.
  42. Astrom M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop 1995;151�64.
  43. Leadbetter WB. Cell-matrix response in tendon injury. Clin Sports Med 1992;11:533�78.
  44. Movin T, Gad A, Reinholt FP, et al. Tendon pathology in long-standing achillodynia. Biopsy findings in 40 patients. Acta Orthop Scand 1997;68:170�5.
  45. Khan KM, Cook JL, Bonar F, et al. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med 1999;27:393�408.
  46. Jozsa L, Balint J, Kannus P, et al. Mechanoreceptors in human myotendinous junction. Muscle Nerve 1993;16:453�7.
  47. Khan K, Jill L, Cook PT. Overuse tendon injuries: where does the pain come from. Sports Medicine Arthroscopy Review 2000;8:17�31.
  48. Khan KM, Cook JL, Maffulli N, et al. Where is the pain coming from in tendinopathy? It may be biochemical, not only structural, in origin. Br J Sports Med 2000;34:81�3.[
  49. Alfredson H, Thorsen K, Lorentzon R. In situ microdialysis in tendon tissue: high levels of glutamate, but not prostaglandin E2 in chronic Achilles tendon pain. Knee Surg Sports Traumatol Arthrosc 1999;7:378�81.
  50. Reddy GK, Stehno-Bittel L, Enwemeka CS. Matrix remodeling in healing rabbit Achilles tendon. Wound Repair and Regeneration 1999;7:518�27.
  51. Vailas AC, Tipton CM, Laughlin HL, et al. Physical activity and hypophysectomy on the aerobic capacity of ligaments and tendons. J Applied Physiol 1978;44:542�6.
  52. Thermann H, Beck A, Holch M, et al. Functional treatment of acute Achilles tendon rupture. A histological, immunohistological and ultrasonographic analysis of the animal model. Unfallchirurg 1999;102:447�57.
  53. Khan KM, Cook JL, Taunton JE, et al. Overuse tendinosis, not tendinitis. Part 1: A new paradigm for a difficult clinical problem. Physician and Sportsmedicine 2000;28:38�48.
  54. Benazzo F Stennardo G, Mosconi M, et al. Muscle transplant in the rabbit's Achilles tendon. Med Sci Sports Exerc 2001;33:696�701.
  55. Fox JM, Blazina ME, Jobe FW, et al. Degeneration and rupture of the Achilles tendon. Clin Orthop 1975;107:221�4.
  56. Merkel KH, Hess H, Kunz M. Insertion tendinopathy in athletes. A light microscopic, histochemical and electron microscopic examination. Pathol Res Pract 1982;173:303�9.
  57. Maffulli N, Barrass V, Ewen SWB. Light microscopic histology of Achilles tendon ruptures. A comparison with unruptured tendons. Am J Sports Med 2000;28:857�63.
  58. Ashe MC, Khan KM, Maffulli N, et al. Pathology of chronic Achilles tendon injuries in athletes. Int Sports Med J 2001;2:
  59. Movin T. Aspects of aetiology, pathoanatomy and diagnostic methods in chronic mid-portion achillodynia. PhD thesis, Karolinska Institute, 1998:1�62.
  60. Burry HC, Pool CJ. Central degeneration of the achilles tendon. Rheumatol Rehabil 1973;12:177�81.
  61. Burry HC. The pathology of the painful heel. Br J Sports Med 1971;6:9�12.
  62. Bestwick CS, Maffulli N. Reactive oxygen species and tendon problems: review and hypothesis. Sports Medicine Arthroscopy Review 2000;8:6�16.
  63. Wilson AM, Goodship AE. Exercise-induced hyperthermia as a possible mechanism for tendon degeneration. J Biomech 1994;27:899�905.
  64. Woo S-LY, Tkach LV. The cellular and matrix response of ligaments and tendons to mechanical injury. In: Leadbetter WB, Buckwalter JA, Gordon SL, eds. Sports-induced inflammation: clinical and basic concepts. Park Ridge, IL: American Academy of Orthopaedic Surgeons, 1990:198�204.
  65. Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984;12:179�84.
  66. Astrom M, Rausing A. Chronic Achilles tendinopathy. A survey of surgical and histopathologic findings. Clin Orthop 1995;316:151�64.
  67. Astrom M, Gentz CF, Nilsson P, et al. Imaging in chronic Achilles tendinopathy: a comparison of ultrasonography, magnetic resonance imaging and surgical findings in 27 histologically verified cases. Skeletal Radiol 1996;25:615�20.
  68. Karjalainen PT, Soila K, Aronen HJ, et al. MR imaging of overuse injuries of the Achilles tendon. AJR Am J Roentgenol 2000;175:251�60.
  69. Movin T, Kristoffersen-Wiberg M, Rolf C, et al. MR imaging in chronic Achilles tendon disorder. Acta Radiol 1998;39:126�32.
  70. Paavola M, Paakkala T, Kannus P, et al. Ultrasonography in the differential diagnosis of Achilles tendon injuries and related disorders. Acta Radiol 1998;39:612�19.
  71. Shalabi A, Kristoffersen-Wiberg M, Aspelin P, et al. MR evaluation of chronic Achilles tendinosis. A longitudinal study of 15 patients preoperatively and two years postoperatively. Acta Radiol 2001;42:269�76.
  72. Soila K, Karjalainen PT, Aronen HJ, et al. High-resolution MR imaging of the asymptomatic Achilles tendon: new observations. AJR Am J Roentgenol 1999;173:323�8.
  73. Kalebo P, Goksor L-A, Sward L, et al. Soft tissue radiography, computed tomography and ultrasonography of partial Achilles tendon ruptures. Acta Radiol 1990;31:565�70.>
  74. Movin T, Kristoffersen-Wiberg M, Shalabi A, et al. Intratendinous alterations as imaged by ultrasound and contrast medium enhanced magnetic resonance in chronic achillodynia. Foot Ankle Int 1998;19:311�17.
  75. Movin T, Guntner P, Gad A, et al. Ultrasonography-guided percutaneous core biopsy in Achilles tendon disorder. Scand J Med Sci Sports 1997;7:244�8.
  76. Clancy WGJ, Neidhart D, Brand RL. Achilles tendonitis in runners: a report of five cases. Am J Sports Med 1976;4:46�57.
  77. Nelen G, Martens M, Burssens A. Surgical treatment of chronic Achilles tendinitis. Am J Sports Med 1989;17:754�9.
  78. Williams JG. Achilles tendon lesions in sport. Sports Med 1986;3:114�35.
  79. Williams JG. Achilles tendon lesions in sport. Sports Med 1993;16:216�20.
  80. Harms J, Biehl G, von Hobach G. Pathologie der Paratenonitis achillea bei Hochleistungssportlern. Archir f�r Orthopadische und Unfall-Chirurgie 1977;88:65�74.
  81. Kvist M. Achilles tendon overuse injuries. A clinical and pathophysiological study in athletes with special reference to Achilles paratenonitis. PhD thesis, University of Turku, 1991.
  82. Kvist M, Jozsa L, Jarvinen M, et al. Fine structural alterations in chronic Achilles paratenonitis in athletes. Pathol Res Pract 1985;180:416�23.
  83. Kvist M, Jozsa L, Jarvinen M, et al. Chronic Achilles paratenonitis in athletes: a histological and histochemical study. Pathology 1987;19:1�11.
  84. Kvist M, Lehto M, Jozsa L, et al. Chronic Achilles paratenonitis. An immunohistologic study of fibronectin and fibrinogen. Am J Sports Med 1988;16:616�23.
  85. Snook GA. Achilles tendon tenosynovitis in long-distance runners. Med Sci Sports Exerc 1972;4:155�8.
  86. Clancy WG. Runners' injuries. Part two. Evaluation and treatment of specific injuries. Am J Sports Med 1980;8:287�9.
  87. Cyriax J. Manipulation trials. BMJ 1980;280:111.
  88. Kellett J. Acute soft tissue injuries: a review of the literature. Med Sci Sports Exerc 1986;18:489�500.
  89. DiGiovanni BF, Gould JS. Achilles tendinitis and posterior heel disorders. Foot and Ankle Clinics 1997;2:411�28.
  90. Rogers BS, Leach RE. Achilles tendinitis. Foot and Ankle Clinics 1996;1:249�59.
  91. Teitz CC, Garrett WEJ, Miniaci A, et al. Tendon problems in athletic individuals. Instr Course Lect 1997;46:569�82.

Statements contained herein have not been evaluated by the Food and Drug Administration (They work for the pharmaceutical industry anyway). These products are not intended to diagnose, treat and cure or prevent disease. Always consult with your professional health care provider before changing any medication.

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