Hi guys! In this video, I’m going to discuss Achilles enthesopathy – which I can never say
properly – what it is, and also what causes it. And then of course, what treatments may be useful.
But actually, I’ve made a whole video about treatment. So, I’m only going to touch on that,
and I’ll link to that video later on. So, for those of you who don't know me,
my name is Maryke. I’m one of the physios from treatmyachilles.com, where you can get online
physiotherapy assessment as well as treatment for your Achilles injuries. So, have a look at the
description of this video if you want the link to our website. Right! So, the word that I can't say,
Achilles enthesopathy, what is it? Now you may also hear that some people say you've got
an enthesitis versus an enthesopathy, and I’ll explain what the difference is with those.
Anywhere where your tendons in your body attach onto bones, we call that area the enthesis.
And an enthesopathy is when you in injure that part where the tendon attaches into the bone. So,
for the Achilles tendon, it's literally where it attaches into the bone there. If that part
is injured, you'll be told that you've got an enthesopathy or an enthesitis. Now, the other
name for it – but thank heaven it is easier to say – is insertional Achilles tendinopathy.
So, it's ... an enthesopathy is exactly the same thing as an Achilles ... insertional Achilles
tendinopathy; it's just the medical term for it. Now, what's the difference between an
enthesopathy and an enthesitis? Basically, the two main reasons why you can develop an injury in
that area. One is, and it's quite common for these people, is if you've got an inflammatory condition
like an inflammatory arthritis … spondyl … spondyloarthritis – I can't say any of these words
– or rheumatoid arthritis or psoriasis, any of those inflammatory type conditions can cause
that part of the tendon to get irritated, and in fact, it can cause inflammation in any tendon
attachments in the body. And if that's the cause of the injury, then you've got to enthesitis,
because ‘-itis’ means inflammation. However if your heel became painful because you overloaded
it through sport or you overstretched it, then actually that forms a tendinopathy,
which means there's no active inflammation in that area at that point; it's actually the
tendon that's injured and breaking down a little bit because there was too much pressure on it.
And the difference between these two is quite important to understand, because if you have got
inflammatory disease as part of your system, then you need to make sure that that's not the driver
for that pain, because that needs to be addressed first. Now, it is absolutely possible to have an
arthritic type condition that's under control and not causing that pain, and so it's not to say that
if you've got arthritic condition that you can't do regular physio for it; it's, just make sure
that it's not an inflammatory reaction, because that needs to be treated first. Now, if you're a
person who doesn't have any of these inflammatory type, arthritis type things, then it's very likely
that your enthesopathy is just ... or insertional Achilles tendinopathy ... is due to overload.
And that area of the Achilles is extremely sensitive to compression forces because, as you
move your ankle and you go over on your foot, the tendon compresses against that part of the bone,
and excessive compression can cause it to become injured. Now, that can be through
doing too much intense sports. So, if it is a lot of hill running or sprinting or going from shoes
that has a little bit of a heel to them to flat shoes, because that would increase that angle and
cause more compression, or it can literally just be, you're not a sporty person but actually what
you've done was you've walked around in shoes with heels on all winter and now it's sunny weather,
switch to flip-flops, and walk miles and miles on holiday in flip-flops with no heel to them, and
that can cause that to over-strain. So, there's plenty of reasons why it can happen. And if that's
the reason, then physiotherapy can really work well for that, to help you get it better. Now,
like I said, I’ve made a whole video about the treatment of insertional Achilles tendinopathy,
because it's quite important that you distinguish that from mid-portion Achilles tendinopathy,
which essentially is a very similar injury process going on there, but the treatment has
to be different because the insertional one has a compression component that it's sensitive to,
whereas the mid-portion one is usually okay with a bit of compression or stretch, and your rehab
program has to be different. So, follow this link if you want to know more about that. So, to recap,
enthesopathy, or Achilles enthesopathy, is just a medical term for insertional
Achilles tendinopathy, and they are exactly the same thing. Take care!