• Leading RIT provider in the Tampay Bay Area
  • Leading RIT provider in the Tampay Bay Area
  • Leading RIT provider in the Tampay Bay Area

Achilles Tendon, Tendinopathy and Tendinosis

The Achilles tendon is located in the back of the lower leg, attaches to the heel bone and connects the leg muscles to the foot.  It is the largest and strongest tendon in the body, giving us the ability to rise up on our toes and plays a large part in how we walk and run.

Marginally trained or conditioned athletes are at the highest risk for developing Achilles tendinosis. The overall incidence of Achilles tendon discomfort is unknown but it occurs in 6% to 18% of all athletes.  Activities that involve repetitive jumping, running, sudden stops and starts, (e.g., basketball, tennis, dancing) increase this risk. The condition often develops after changes in activity level, training on poor surfaces, or wearing inappropriate footwear.

Achilles tendinosis may be caused by a single event of overstressing the tendon, or it may result from a series of stresses that produce small tears over time that do not heal. Tendinosis at the heel is more common in those over 40.

Recent research revealed small blood vessels and nerves growing in to the areas of tendinosis.  The presence of these nerves explains the discomfort. 

Current treatments are directed towards abolishing the areas of new blood vessels by injection therapy.   This results in reversing the nerves' ingrowth, ending area discomfort and, in many cases, restoring normal appearance and function.

Dr. Linetsky will thoroughly discuss treatment options with you.

Publications on the subject are in the library section.

Alfredson H, Lorentzon R. (2007) Sclerosing polidocanol injections of small vessels to treat the chronic painful tendon. Cardiovasc Hematol Agents Med Chem. Apr; 5(2):97-100.


The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carrier. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + color Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anesthesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall.

 In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing polidocanol injections, targeting the area with neovessels outside the tendon.

 Two-year follow ups have showed remaining good clinical results, and Sonographically signs of remodeling with a significantly thinner tendon with a more normal structure. Whether the effects of polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation.  PMID: 17430133



Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong AD.


Sonographically guided intratendinous injection of hyperosmolar dextrose to treat chronic tendinosis of the Achilles tendon: a pilot study.


AJR Am J Roentgenol. 2007 Oct;189(4):W215-20.


Department of Radiology, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada. This e-mail address is being protected from spambots. You need JavaScript enabled to view it


OBJECTIVE: Chronic tendinosis of the Achilles tendon is a common overuse injury that is difficult to manage. We report on a new injection treatment for this condition. SUBJECTS AND METHODS: Thirty-six consecutive patients (25 men, 11 women; mean age, 52.6 years) with symptoms for more than 3 months (mean, 28.6 months) underwent sonographic-guided intratendinous injection of 25% hyperosmolar

dextrose every 6 weeks until symptoms resolved or no improvement was shown. At baseline and before each injection, clinical assessment was performed using a visual analogue scale (VAS) for pain at rest (VAS1), pain during normal daily activity (VAS2), and pain during or after sporting or other physical activity (VAS3). Sonographic parameters including tendon thickness, echogenicity, and neovascularity were also recorded.

 Post treatment clinical follow-up was performed via telephone interview. RESULTS: Thirty-three tendons in 32 patients were successfully treated. The mean number of treatment sessions was 4.0 (range, 2-11). There was a mean percentage reduction for VAS1 of 88.2% (p < 0.0001), for VAS2 of 84.0% (p < 0.0001), and for VAS3 of 78.1% (p < 0.0001).

The mean tendon thickness decreased from 11.7 to 11.1 mm (p < 0.007). The number of tendons with anechoic clefts or foci was reduced by 78%. Echogenicity improved in six tendons (18%) but was unchanged in 27 tendons (82%).

Neovascularity was unchanged in 11 tendons (33%) but decreased in 18 tendons (55%); no neovascularity was present before or after treatment in the four remaining tendons.

Follow-up telephone interviews of the 30 available patients a mean of 12 months after treatment revealed that 20 patients were still asymptomatic, nine patients had only mild symptoms, and one patient had moderate symptoms.

CONCLUSION: Intratendinous injections of hyperosmolar dextrose yielded a good clinical response--that is, a significant reduction in pain at rest and during tendon-loading activities-in patients with chronic tendinosis of the Achilles tendon.



PMID: 17885034 [PubMed - indexed for MEDLINE]

Maxwell NJ, Ryan MB, Taunton JE, Gillies JH, Wong AD.



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