Achilles tendonopathy

Last evidence check May 2014.

Principal authors: Jim Barrie, Rebecca Hope and Marie Wilson


de Jonge (2011) analysed the records of 50000 general practice patients in the Netherlands and found an incidence of 2.35/1000 adult patients, so this is a reasonably common condition.

Most studies describe non-insertional tendonopathy in athletic populations, commonly in their 30s and 40s. In such populations

Other series look at older less athletic populations in their 40s and over, in whom peritendonitis is less common and non-insertional tendonopathy more frequent.

Nicol et al (2006) found ultrasound evidence of tendonopathy in 59% of the tendons of 126 asymptomatic subjects with a mean age of 33y.

There are associations with (Holmes and Lin 2006, Corrao et al 2006):

Gaida (2010) studied fasting seum lipids in 60 patients with non-insertional Achilles tendonopathy and 60 matched controls. They found a pattern of dyslipidaemia consistent with insulin resistance and a possible association with the metabolic syndrome. Gaida suggested that cardiovascular disease research may shed light on tendonopathy.

Natural history

There is only one long-term outcome study. Paavola (2000) reported 83 patients followed up for 8 years after non-surgical treatment:

On the basis of Paavola's series it appears that Achilles tendonopathy is a relatively benign condition, which may progress slowly but rarely leads to rupture in those who present initially with pain. About 30% of patients fail non-operative treatment and are offered surgery.