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What is Achilles Paratenonitis?

Physical Therapy in Grapevine for Foot

Q: Can you tell me what paratenonitis of the Achilles tendon is? I've heard of tendonitis but what's paratenonitis? Is it just a different way to spell the same thing?

A: Tendon disorders of the foot and ankle come in all sizes and shapes. There are overuse injuries, tendinosis, paratenonitis, bursitis, and both acute and chronic Achilles tendon ruptures.

Tendinosis is degeneration of the tendon without inflammation. It is caused by microtrauma or aging leading to thickening of the tendon. Bursitis, a painful inflammation of the retrocalcaneal bursa is caused by compression of the bursa located between the Achilles tendon and the calcaneus (heel bone). A bursa is a round or oval pad that reduces friction between two areas that rub together. This condition occurs most often in uphill runners.

Paratenonitis refers to inflammation of the paratenon, which is a thin membrane around the tendon. The paratenon helps the tendon glide up and down smoothly as the Achilles tendon contracts and relaxes to move the foot and ankle up and down. It is a common problem in middle- and long-distance runners.

Paratenonitis can be treated with Physical Therapy and other nonoperative methods first before considering surgery. Ice therapy or other modalities are used to get control of the pain and swelling. The therapist will help correct training errors and problems with limb alignment, improve flexibility, and teach eccentric stretching/strengthening exercises.

Steroid injections aren't used because they can weaken the tendon structure and lead to tendon rupture. But many patients are helped by nonsteroidal antiinflammatory drugs. When surgery is advised, it's for chronic problems that just won't clear up with conservative care. The surgeon removes any adhesions or thickened areas of the paratenon.

Reference: Daniel S. Heckman, MD, et al. Tendon Disorders of the Foot and Ankle, Part 2. Achilles Tendon Disorders. In The American Journal of Sports Medicine. June 2009. Vol. 37. No. 6. Pp. 1223-1234.