[Rare causes and differential diagnoses of Achilles tendinitis]

Especially in sports disciplines involving high uniform stress by running, such as all running competitions in athletics, the condition known as achillodynia is a much-dreaded lesion. We evaluated an own series of 74 consecutive patients who reported pain at the achilles tendon, with regard to etiological aspects. It was a remarkable fact that besides the well-known classical reasons (degenerative changes in the center of the achilles tendon with spindle-shaped distension, aseptic irritated condition of the paratenon, bursitis subachillea mostly associated with Haglund's exostosis) numerous other syndromes may seem to be achilles tendon pain to individual athletes. To arrive at on-target therapy directed etiologically at the root cause of the disease, it will be necessary to differentiate them from one another: insertion tendopathies of the achilles tendon; metabolic diseases; arthritis and chondropathic disease of the ankle joint; hallux rigidus --rotation anomalies; tibia vara; os trigonum impingement syndrome --tendovaginitis of the flexor tendon at the retinaculum flexorum; stress fractures (calcaneus, fibula, tibia) Diagnosis is assisted, besides a detailed and exact clinical examination and an inspection of the sports shoes worn by the patient, by a biomechanical analysis of the running behaviour, an x-ray of the ankle joint, sonographic examination and clarification with the help of laboratory examinations, i.e. clinical pathology.