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Ankle Pain

Achilles Paratenonitis

Minute Read


Posted 10 months ago


Last updated: 03/12/2022


by James McCormack

What is Achilles Paratenonitis?

The Achilles tendon sits at the back of the ankle connecting the calf muscle to the heel bone. It is surrounded by a loose areolar connective tissue sheath called the Achilles Paratenon. The function of the Achilles Paratenon is to protect the Achilles Tendon from surrounding structures and to reduce friction. The Paratenon has a very good blood supply and when irritated, it can become painful and inflamed leading to Achilles Paratenonitis.

In this article, we will explore the causes, symptoms, diagnosis, and treatment for Paratenonitis. It is sometimes referred to as Achilles Tenosynovitis.

Achilles Paratenonitis Causes

Achilles Paratenonitis is often the result of an acute overload of the Achilles tendon or friction from a bony protuberance such as Haglund’s deformity. An overload is the result of a sudden increase in running or impact activities. Other causes can be poorly fitted footwear that causes friction of the paratenon.


Sharp constant pain along the entire Achilles Tendon is associated with Achilles Paratenonitis.

There is audible crepitus when moving to flex the foot while it is common to be swelling of the Achilles Tendon. The space between the tendon and the sheath fills with fluid to give it a swollen sausage-like appearance.


If you have any symptoms of Achilles Paratenonitis, it is recommended to see a Sports Medicine Doctor or Physical Therapist. After a careful clinical interview followed by a clinical assessment, where a swollen Achilles Tendon is normally observed alongside a positive Achilles tendon pinch test, along the length of the tendon.

A referral for imaging such as an ultrasound scan or an MRI are the most accurate form of imaging for Achilles Paratenonitis.




Picture of Ultrasound Achilles Paratenonitis

How do you treat Achilles Paratenonitis?

Treatment for Achilles Paratenonitis should be under the care of a Physical Therapist or Podiatrist. In the acute stage offloading the area with non-steroidal anti-inflammatories can be highly effective. A heel raise in a shoe can shorten the Achilles Tendon and Isometric strengthening exercises are helpful.

Offloading may be in the form of dramatically reducing the step count or using a walker boot can be beneficial for extremely irritable cases. Surgery is not needed for this type of condition as it normally settles quickly with the correct management.

Isometric Strengthening Exercise for Achilles Paratenonitis

  • Stand of the floor with your knees bent
  • Keep your knees in the same position and slowly raises your heels
  • Stay in this position for 45 seconds
  • Slowly lower to your starting position
  • Repeat 4 times

Physiotherapy with James McCormack

This is not medical advice and we recommend a consultation with a medical professional such as James McCormack to achieve a diagnosis. He offers Online Physiotherapy Appointments for £45.

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