Tendinopatia Aquiliana

The American Journal of Sports
Medicine
http://ajs.sagepub.com/

Achilles tendinitis and peritendinitis: Etiology and treatment
D.B. Clement, J.E. Taunton and G.W. Smart
Am J Sports Med 1984 12: 179
DOI: 10.1177/036354658401200301
The online version of this article can be found at:
http://ajs.sagepub.com/content/12/3/179

Published by:
http://www.sagepublications.com

On behalf of:American Orthopaedic Society for Sports Medicine

Additional services and information for The American Journal of Sports Medicine can be found at:
Email Alerts: http://ajs.sagepub.com/cgi/alerts
Subscriptions: http://ajs.sagepub.com/subscriptions
Reprints: http://www.sagepub.com/journalsReprints.nav
Permissions: http://www.sagepub.com/journalsPermissions.nav

Downloaded fromajs.sagepub.com at UNIVERSITY OF MICHIGAN on September 24, 2009

Achilles tendinitis and peritendinitis:
Etiology and treatment
D. B.

CLEMENT,* MD, FACSM, J. E. TAUNTON, MD, FACSM, AND G.

From the British Columbia

W. SMART

Sports Medicine Clinic, University of British Columbia, Vancouver,
British Columbia, Canada

Achilles tendinitis with peritendinitis, yet often neither one
of thesefactors can be implicated. This observation has
prompted us to investigate other mechanisms.
The purposes of this paper are to present the results of
conservative treatment of 109 runners with overuse injury
to the Achilles tendon and to discuss the implications of
functional overpronation as an etiological factor in this
condition.

ABSTRACT
One hundred nine runners were treatedconservatively
without immobilization for overuse injury to the Achilles
tendon. Treatment strategies were directed toward rehabilitation of the gastrocnemius/soleus muscle-tendon
unit, control of inflammation and pain, and control of
biomechanical parameters. One fair, 12 good, and 73
excellent results were reported, with a mean recovery
time of 5 week.Followup was incomplete in 23 cases.
The threemost prevalent etiological factors were
overtraining (82 cases), functional overpronation (61
cases), and gastrocnemius/soleus insufficiency (41

MATERIALS AND METHODS
Over a 2 year period, from January 1978 to January 1980,
109 runners with Achilles tendon injury were seen by two of
the presenting authors. Patients who exhibited total rupture
or gross partial rupture of the Achillestendon were excluded
from this retrospective study. Runners were included who
had Achilles tendinitis with peritendinitis; peritendinitis
referring to inflammation of the peritendon and tendinitis
inferring devitalization and disruption of tendon fascicles
due to repetitive microtrauma of overuse. Most runners
presented with symptoms of gradual evolution of pain and
swelling in the Achillestendon 2 to 3 cm proximal to the
insertion at the calcaneus. Running precipitated intensification of the pain often associated with change in gait.
A thorough history was taken to identify previous injuries,
training errors, specific symptoms, and activities that relieved or aggravated each patient’s condition. Examination
of the site of pain revealed focal tenderness, induration, and
frequentlycrepitus just proximal to the insertion of the
Achilles tendon. Pain could often be precipated by having
the patient skip or hop on the symptomatic foot during the
examination. The alignment of the tibia, heel, and forefoot
were measured with a goniometer for each patient. Patients
were then classified as exhibiting an unremarkable, mild,
moderate, or severe degree of varus alignment. Varusalignment describes a notable degree of tibial varum, subtalar
and/or forefoot varus, examined in the nonweighted position
according to James et al.9 that necessitates functional over-

cases).
The authors speculate that runners are susceptible
to Achilles tendinitis with peritendinitis due to microtrauma produced by the eccentric loading of fatigued
muscle, excess pronation producing...