From the Guidelines
Laboratory tests are not necessary for diagnosing calcific Achilles tendinitis, as imaging studies like X-rays, ultrasound, or MRI are more valuable for diagnosis, showing calcium deposits within the tendon. The diagnosis of calcific Achilles tendinitis is primarily clinical, confirmed by imaging, and labs may include complete blood count (CBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and uric acid levels to rule out other conditions like infection or gout 1. These tests are usually normal in calcific Achilles tendinitis but help exclude other pathologies.
Key Points to Consider
- Calcium and phosphate levels may be checked but are typically normal as the condition represents a local calcification process rather than a systemic calcium metabolism disorder.
- Imaging studies, as outlined in the study 1, are more useful for diagnosing calcific Achilles tendinitis, with plain radiography showing calcific tendinosus, calcaneal avulsion fracture, and soft-tissue swelling.
- The absence of elevated inflammatory markers helps differentiate this condition from infectious processes, while normal uric acid levels help rule out gout.
- Laboratory testing serves primarily as an adjunct to clinical evaluation and imaging in cases where the diagnosis is unclear or where other conditions need to be excluded, as seen in the study 1.
Imaging Studies
- Plain radiography may show calcific tendinosus, calcaneal avulsion fracture, and soft-tissue swelling 1.
- Ultrasonography can demonstrate tendon thickening and heterogeneous echogenicity 1.
- MRI is useful for showing partial tendon tears, tendon thickening, bursitis, and chronic degenerative changes 1.
From the Research
Diagnostic Techniques
- The diagnosis of calcific Achilles tendinitis is typically clinical, with patients presenting with localized pain that is worse with tendon-loading activities 2
- Imaging modalities may be helpful in the diagnosis of difficult cases or in the planning of interventional procedures 2
Treatment Options
- Conservative first-line therapy includes reduction of activity levels, administration of non-steroidal anti-inflammatory drugs (NSAID), adaptation of footwear, heel wedges and orthoses or immobilization 3
- Eccentric stretching exercises should be integral components of physiotherapy and can achieve a 40% reduction in pain 3
- Extracorporeal shock wave therapy has been shown to reduce pain by 60% with a patient satisfaction of 80% 3
- Operative therapy is indicated after 6 months of unsuccessful conservative therapy 3
- The posterior midline approach can achieve satisfactory outcomes in the treatment of significantly calcified insertional Achilles tendinopathy 4
- Reattachment with bone anchors is a safe and effective treatment for recalcitrant calcific insertional Achilles tendinopathy 5
- US-guided percutaneous irrigation might be a safe, technically feasible, mini-invasive, and effective treatment for Achilles calcific tendinopathy 6
Specific Considerations
- Insertional and non-insertional Achilles tendinopathy have distinct features and differences for therapeutic paradigms 2
- Gastrocnemius recession should be performed for patients with gastrocnemius contracture to improve the surgical outcome 4
- Tendoscopy is a promising treatment option for isolated retrocalcaneal bursitis and has shown similar success rates to open debridement with significantly lower complication rates 3