Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.
Paratenon is a loose areolar connective tissue sheath that covers extra articular tendons such as achilles tendon, quadriceps tendon, distal biceps tendon, gluteal tendons.
Paratenon reduces the friction between the tendon and the surrounding structure during movement. So it protects the tendon during movement.
Achilles paratenonitis means inflammation of the achilles paratenon. Achilles paratenonitis is sometimes referred as Achilles tenosynovitis or achilles tendovaginitis
Causes of achilles Paratenonitis
1 Overuse- Sudden increased activity of the achilles tendon.
2 Repeated use causing trauma and irritation to the achilles paratenon. Therefore this condition commonly occurs in runners.
3 Poorly fitted shoes causing excessive pressure on the back of heel.
4 In people with Haglund’s deformity- because of the rubbing of the tendon with the heel bone.
( Haglund’s deformity is a bony prominence at the upper part of the calcaneus bone).
Symptoms of achilles Paratenonitis
Symptoms may develop suddenly or gradually.
1 Pain at the back and above the heel.
2 Along the course of the achilles tendon there may be swelling, pain and stiffness.
3 Pain usually increases during activity.
4 There may be audible crepitus during movement of the ankle.
Diagnosis of achilles Paratenonitis
History taking for symptoms of achilles paratenonitis.
Physical examinations- On palpation tenderness along the course of achilles tendon.
Investigations-
Ultrasonography- There may be linear hypoechoic fluid lining around the tendon. When it becomes chronic there is associated hyperemia on color Doppler study.
MRI- can diagnose achilles paratenonitis. Increased signal intensity on STIR and fat suppressed T2 – weighted images completely or partially surrounding the achilles tendon.
Treatment of achilles Paratenonitis
1 Rest- In acute conditions the rest of the achilles tendon movement can cause dramatic pain relief.
2 Ice therapy- Application of ice wrapped with a cloth on the painful area for maximum 20 minutes several times a day is helpful for pain relief. Wrap the ice properly to prevent skin damage.
3 Pain killer- Nonsteroidal anti-inflammatory drugs reduce pain when there is acute pain.
4 Shoes- Use of heel raiser for shoes decreases the stress on the achilles tendon and improves the condition.
5 Physical therapy
Stretching exercise- Different types of stretching exercises under guidance of a physical therapist can speed up recovery.
6 Brisement- In this procedure local anesthetic and saline is injected into the space between the achilles tendon and paratenon under ultrasound guidance to break down its adhesion with the achilles tendon. The procedure is repeated up to 3 times. Success rate is 50%.
7 Surgery- Surgical treatment may be necessary when all treatment modalities fail even after 6 months of non-surgical therapy.
Any adhesion or thickened area of paratenon on the back and both sides of the tendon is removed. The front part of the paratenon is spared to maintain its blood supply.
Success rate of this procedure is 87%.
Achilles tendon rupture.
Achilles tendinitis.
Achilles tendinosis.
Retrocalcaneal bursitis.
