[Achillodynia]

Achilles tendinitis and posterior heel pain are caused by a wide variety of disorders. Understanding of the functional anatomy and pathomechanics of the Achilles tendon is essential for diagnosis and adequate therapy. Possible causes for heel pain include paratenonitis, tendinitis, tendinitis with partial rupture, insertional tendinitis, subachilles and retroachilles bursitis, Haglunds deformity and calcaneal spur. These chronic overuse symptoms may be triggered by pes plano valgus, lateral ankle instability, hyperlaxity, malalignement of the lower extremity, forefoot or hip disorders. In obese patients the deforming forces on the rear foot position and thereby overuse of the achillis tendon due to the overweight are increased. Lack of training with loss of muscular compensation or forefoot disorders also favor overuse problems. A sudden increase of load in an attempt of loosing weight by unaccustomed exercise, without giving the tissue adequate time for adaptation may lead to the start of the symptoms. Therapy of Achilles tendinitis is preferably conservative, in chronic cases operative therapy depends on the structures involved.