Achilles Tendon Research A-J

Key Points from peer reviewed Achilles tendon research by scientists, doctors, sport trainers, educators, and physical therapists whose last name starts with A-J. is based on this peer reviewed Achilles tendon research.

Heavy-load eccentric calf muscle training for the treatment of chronic Achilles tendinosis.

Note: This was an especially important study.
Alfredson, H.; Pietila, T.; Jonsson, P.; Lorentzon, R. (1998) American Journal of Sports Medicine 26, 360–66. Key point: After a 12 week training period of eccentric calf exercises, 15 recreational athletes were back to their previous running activities. A control group underwent: rest, anti-inflammatory drugs, change of shoes orthoses, and physical therapy, but did not improve.

Etiology, diagnosis, and treatment of tendonitis: An analysis of the literature

Almekinders, L.C.; Temple, J.D. (1998) Medicine and Science in Sports and Exercise 30, 1183–90. Key points: a) the reasons why Achilles tendons are susceptible to injury have not been rigorously studied in scientific trials, b) there is no evidence to suggest that anti-inflammatory drugs help with the treating the Achilles tendon, and c) age correlates to the risk of Achilles tendon injuries, with the 30-50 year old age bracket at the highest risk.

Surgical management of chronic Achilles tendinitis

Anderson, D.L.; Taunton, J.E.; Davidson, R.G. (1992) Clinical Journal of Sport Medicine 2, 38–42. Key point: confirmed the Clement et al. 1984 study that 85% of runners who underwent an Achilles injury recovery program built around better footwear, relative rest, stretching, eccentric strengthening, physical therapy, and ice reported excellent results.

Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon

Andres, Brett M.; Murrell, George A. C. (2008) Clinical Orthopaedics and Related Research 466(7)1539–1554 Key Points: “..eccentric strengthening exercises are a good form of physical therapy while physical therapy modalities such as iontophoresis, ultrasound, phonophoresis, and low-level laser treatment lack sufficient evidence at this time. Corticosteroids provide temporary pain relief but do not appear to have any established longer-term benefit. When these modalities fail, other options should be considered… Glyceryl trinitrate patches are a good next step… ESWT is an excellent option for calcific tendinopathy of the shoulder, but more rigorous testing is required before advocating its use for other types of tendinopathy. Sclerosing polidocanol injections appear to provide pain relief if the involved tendon has documented neovascularization seen on Doppler ultrasound. Surgical débridement remains a last option for the treatment of tendinopathy because this has considerable cost and morbidity and modest success in treating chronic tendinopathy.”

The arterial anatomy of the Achilles tendon: Anatomical study and clinical implications

Chen, Tony M.; Rozen, Warren M.; Pan, Wei-ren; Ashton, Mark W.; Richardson, Martin D.; Taylor, G. Ian. (2009) Clinical Anatomy vol. 22 issue 3, 377–385. Key Points: a) Blood is supplied to the midsection of the Achilles by the peroneal artery, and to the proximal and distal sections supplied by the posterior tibial artery; b) the midsection is markedly more hypovascular, and has the highest risk of rupture and surgical complications, c) Individuals with particularly poor supply of the midsection may be at increased risk of tendon rupture, and d) tendon operations should consider the blood supply route from the peroneal artery.

Diagnosis and treatment of acute Achilles tendon rupture

Chiodo, CP; Glazebrook, M; Bluman, EM; Cohen, BE; Femino, JE; Giza, E; Watters, WC Goldberg, MJ;Keith, M; Haralson, RH Turkelson, CM; Wies, JL; Raymond, L; Anderson, S; Boyer, K; Sluka, P. (2010) Journal of the American Academy of Orthopaedic Surgeons Aug;18(8):503-10  Key Points: The American Academy of Orthopaedic Surgeons approved this clinical practice guideline on December 4, 2009.  This guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. None of the 16 recommendations made by the work group was graded as strong; most are graded inconclusive; four are graded weak; two are graded as moderate strength; and two are consensus statements. The two moderate-strength recommendations include the suggestions for early postoperative protective weight bearing and for the use of protective devices that allow for postoperative mobilization.

Achilles tendinitis and peritendinitis: Etiology and treatment

Clement, D.B.; Taunton, J.E.; Smart, G.W. (1984). American Journal of Sports Medicine 12, 179–84. Key Points: a) Achilles tendons may be prone to injury due to a combination the Achilles tendon’s poor blood supply and the whipping action of the Achilles tendon caused by ankle pronation, b) Achilles tendon injuries may be caused by sudden increases in training distances, too many speed sessions, increased hill running, heavy training after a layoff, and inflexibility of the calf caused by too much training and not enough stretching, c) injury can be caused by tight inflexible calf muscles, and either hyper mobile flat feet or high arched cavus chunk feet, d) a 7-15 mm heel raise should be added to running shoes, either as an addition to the heel or as an insert inside the shoe, and e) 85% of 86 runners who underwent an Achilles injury recovery program built around better footwear, relative rest, stretching, eccentric calf strengthening, physical therapy, and ice reported excellent results.

On Muscle, Tendon and High Heels.  

Csapo, R.; Maganaris, C.N.; Seynnes, O.R.; Narici, M.V. (2010) Journal of Experimental Biology 213 3582-2588.  Key Point: Long-term use of high-heeled shoes induces shortening of the Gastrocnemius medialis muscle fascicles and increases Achilles tendon stiffness.

Clarification of the Simmonds–Thompson test for rupture of an Achilles tendon

Douglas, J; Kelly, M; Blachut, P. (2009)  Canadian Journal of Surgery / Journal canadien de chirurgie 52(3): E40-41.  Key Point:  When treatment decisions are based on whether a rupture is partial or complete and whether the soleus is involved, the Simmonds–Thompson test alone is insufficient. Although the test indicates a substantial injury to the tendon, it cannot be regarded as diagnostic of a complete rupture:  an isolated disruption of only the gastrocnemius portion of the tendon will also give a positive result.

Painful Conditions in the Achilles Tendon Region in Elite Badminton Players

Fahlström, M; Lorentzon, R; Alfredson, H. American Journal of Sports Medicine 30:51-54 (2002). Key point: The players with painful Achilles tendons spent more time in total, badminton, endurance and strength training. There were no differences in age, sex, or body mass index between the players with and without painful Achilles tendons.

High-Energy Extracorporeal Shock Wave Therapy as a Treatment for Insertional Achilles Tendinopathy

Furia, J.P. (2006) American Journal of Sports Medicine vol. 34 no. 5 733-740. Key Points: Extracorporeal shock wave therapy is an effective treatment for chronic insertional Achilles tendinopathy. Local field block anesthesia may decrease the effectiveness of this procedure.

Ultrasonic assessment of extracellular matrix content in healing Achilles tendon

Ghorayeb, S.R.; Shah, N.V.; Edobor-Osula, F.; Lane, L.B.; Razzano, P.; Chahine, N.; Grande, D.A. (2012)  IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control vol. 59 issue: pages: 694 – 702.  Key Point:  Ultrasound can be an effective imaging technique in assessing the degree of tendon healing, and can be used to correlate structural properties of Achilles tendons

Sonographic incidence of tendon microtears in athletes with chronic Achilles tendinosis

Gibbon, W.W.; Cooper, J.R.; Radcliffe, G.S. (1999). British Journal of Sports Medicine 33, 129–30. Key point: Tiny but repetitive micro tears in the Achilles tendon may be caused by the calf muscles’ rapid eccentric shortening at heel strike followed by rapid contraction contraction at toe-off.

Range of motion, muscle torque and training habits in runners with and without Achilles tendon problems

Haglund-Åkerlind, Y.; Eriksson, E. (1993) Knee Surgery, Sports Traumatology and Arthroscopy 1, 195–99. Key points: a) runners with Achilles tendon injures have usually trained for significantly more years and run significantly more distance per week than runners without Achilles tendon injuries, and b) the calf muscles of runners with Achilles tendon injuries have significantly less eccentric strength than do those of uninjured runners.

Achilles Tendon Rupture – A Review of Etiology, Population, Anatomy, Risk Factors, and Injury Prevention

Hess, Gregory William (2009) Foot & Ankle Specialist vol. 3 no. 1 29-32. Key Points: a) A 2 in 100 000 individual Achilles tendon injury rate increased to a 12 in 100 000 in less than 10 years, b) Natural aging allows predisposing chronic degeneration of the tendon, c) Blood flow decreases and stiffness increases with aging to decrease the ability to withstand stress, d) Regular physical activity as athletes age promotes tendon hypertrophy, increases nutrient delivery, and reduces collagen fiber fatigue.

Achilles tendon rupture repair: biomechanical comparison of the triple bundle technique versus the Krakow locking loop technique

Jaakkola, J.I.; Hutton, W.C.; Beskin, J.L.; Lee, G.P.  (2000) Foot & Ankle International / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society Jan; 21(1):14-7 Key Point:  There is a statistically significant superiority of 2.8 to 1 (p < 0.001) in favor of the triple bundle technique.

Barefoot Running Claims and Controversies – A Review of the Literature

Jenkins, D.W.; Cauthon, D. J. (2011) Journal of the American Podiatric Medical Association vol 101 no. 3 231-246. Key Points: Although there is no evidence that either confirms or refutes improved performance and reduced injuries in barefoot runners, many of the claimed disadvantages to barefoot running are not supported by the literature. Nonetheless, it seems that barefoot running may be an acceptable training method for athletes and coaches who understand and can minimize the risks.


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