Pathogenesis, Diagnosis, and Conservative Management of Achilles Tendinopathy

Achilles tendinopathy (AT) is a prevalent musculoskeletal disorder that affects both athletes and the general population.Its pathogenesis is multifactorial, encompassing repetitive mechanical overload, impaired collagen synthesis, tendon fiber disorganization, neovascularization, and aberrant neural ingrowth.These processes collectively disrupt normal tendon healing and contribute to chronic pain, and functional impairment.Diagnosis relies primarily on patient history and clinical examination, with imaging serving as a valuable adjunct.Although surgical intervention may be required in AT, the majority of patients respond favorably to conservative management.Exercise therapy, particularly eccentric loading, remains the cornerstone of treatment, with the strongest evidence supporting its role in pain reduction and functional recovery.Adjunctive strategies-including physical therapy modalities, pharmacologic and biologic injections, and orthotic interventions-have been investigated, though their effectiveness remains inconsistent.Patient education, activity modification, and load management are critical for sustaining long-term outcomes.This narrative review provides an overview of current knowledge on AT and highlights evidence-based conservative management strategies to guide clinical practice and mitigate disease progression.(