Open AccessMid‐portion Achilles tendinopathy: why painful? An evidence‐based philosophy
Author(s) -
Sterkenburg Maayke N.,
Dijk C. Niek
Publication year - 2011
Publication title -
knee surgery, sports traumatology, arthroscopy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.806
H-Index - 125
eISSN - 1433-7347
pISSN - 0942-2056
DOI - 10.1007/s00167-011-1535-8
Subject(s) - tendinopathy , medicine , achilles tendon , asymptomatic , tendon , surgery , chronic pain , physical therapy , physical medicine and rehabilitation
Abstract Chronic mid‐portion Achilles tendinopathy is generally difficult to treat as the background to the pain mechanisms has not yet been clarified. A wide range of conservative and surgical treatment options are available. Most address intratendinous degenerative changes when present, as it is believed that these changes are responsible for the symptoms. Since up to 34% of asymptomatic tendons show histopathological changes, we believe that the tendon proper is not the cause of pain in the majority of patients. Chronic painful tendons show the ingrowth of sensory and sympathetic nerves from the paratenon with release of nociceptive substances. Denervating the Achilles tendon by release of the paratenon is sufficient to cause pain relief in the majority of patients. This type of treatment has the additional advantage that it is associated with a shorter recovery time when compared with treatment options that address the tendon itself. An evidence‐based philosophy on the cause of pain in chronic mid‐portion Achilles tendinopathy is presented. Level of evidence V.