The pathogenesis of Achilles tendinopathy: a systematic review

Foot Ankle Surg. 2014 Sep;20(3):154-9. doi: 10.1016/j.fas.2014.02.010. Epub 2014 Mar 12.


Achilles tendinopathy is a degenerative, not an inflammatory, condition. It is prevalent in athletes involved in running sports. A systematic literature review on Achilles tendon tendinopathy has been performed according to the intrinsic (age, sex, body weight, tendon temperature, systemic diseases, muscle strength, flexibility, previous injuries and anatomical variants, genetic predisposition and blood supply) and extrinsic risk factors (drugs and overuse), which can cause tendon suffering and degeneration. Different theories have been found: Neurogenic, Angiogenic, Impingement and "Iceberg" Hypotheses. Multiple databases were utilized for articles published between 1964 and 2013. The different hypothesis were analyzed, differently considering those concerning the pathogenesis of tendinopathy and those concerning the etiology of complaints in patients. This review of the literature demonstrates the heterogeneity of Achilles tendinopathy pathogenesis. Various risk factors have been identified and have shown an interaction between them such as genes, age, circulating and local cytokine production, sex, biomechanics and body composition.

Keywords: Achilles pathogenesis; Achilles tendinopathy; Achilles tendon; Tendon degeneration.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Achilles Tendon*
  • Humans
  • Risk Factors
  • Tendinopathy / etiology*
  • Tendinopathy / therapy