THE ACHILLES-TENDON IN SPORTS

Achillodynia is a generic term for various types of ailments in the re gion of the Achilles tendon. For adequate therapy a specific diagnosis is absolutely necessary. Besides an accurate anamnesis and the right choice of terrain and shoes, as well as a clinical examination where o ne has to specifically keep an eye on muscular imbalance between the g astrocnemius and the soleus muscle and disorders of the ligamentary co ntrol of the calcaneus caused by fibular ligament instabilities, a pro cedure such as radiology, ultrasound, and MR imaging is inevitable. Fr om the differential diagnosis point of view a distinction between peri tendinitis, mechanically triggered bursitis (calcaneal and subachillea l), bony alterations of the calcaneus (calcaneus spur, Haglund exostos is persistent nucleus of the apophysis, fatigue fracture, etc) and a p artial or total rupture (a one-time occurrence or multiple occurrences ) has to be made. Occasionally, entrapment of the ramus calcaneus of t he sural nerve causes calcaneal pain. If clinically not confirmed, lum bar pain ought to be taken into consideration (discopathy, Bechterew d isease, etc). Metabolic disorders (especially uric acid) and underlyin g rheumatic diseases must be excluded. The therapy of achillodynia inc ludes local and peroral antiphlogistic medication as a concomitant mea sure. More important is the causal influence of etiological factors, i .e., the correction of muscular imbalance, ensuring control of the cal caneus through bandages and adjustment of sport shoes, changes in trai ning buildup and exercise intensity, just to mention a few. If necessa ry, surgically splitting the peritendineum, sanitation of a partial ru pture, bursectomy and removal of mechanically obstructive exostosis mu st be done.