The Spectrum of Achilles Disease
The Achilles is the strongest tendon in the body - and one of the most commonly injured. The clinical picture ranges from chronic, mid-substance tendinosis (degenerative thickening) to insertional tendinopathy (pain at the back of the heel), to a sudden, audible rupture during sport.
Tendinosis & Tendinopathy
Pain that builds gradually, worse in the morning and after activity, with a palpable thickening of the tendon. Treatment is methodical: eccentric calf loading, footwear modification, heel lift in some cases, possible shockwave therapy, and - when conservative care plateaus - gastrocnemius recession or tendon debridement.
Acute Rupture
A sudden “pop,” the sense of being kicked in the calf, and immediate weakness in pushing off. Diagnosis is largely clinical (the Thompson test) supplemented by ultrasound or MRI when needed. Rupture can be managed operatively (lower re-rupture rate, faster strength recovery) or with functional bracing - the right choice depends on age, activity level, and timing of presentation. Dr. O’Carroll discusses both pathways openly.