The Achilles tendon has no true synovial tendon sheath. Instead it is surrounded by the paratenon, a loose areolar connective tissue sleeve that allows tendon gliding and provides the extrinsic blood supply from its inner surface. Paratenon inflammation (peritendinitis) produces diffuse Achilles tenderness and crepitus along the full tendon length, distinct from the focal mid-portion tendinopathy that involves the tendon substance.
| Location | Back of the lower leg, around the Achilles tendon from the musculotendinous junction to near the calcaneus |
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Lets the Achilles tendon glide against the surrounding tissue and carries many of the small vessels that supply it; it is the site of inflammation in paratenonitis.
Achilles peritendinitis presents with diffuse tenderness along the full Achilles length and a painful crepitus palpable during ankle movement, in contrast to mid-portion tendinopathy which produces focal nodular tenderness at the avascular zone 2-6 cm above the insertion. Treatment of peritendinitis focuses on load management and anti-inflammatory measures; surgical paratenon release is rarely required.
Paratenon inflammation producing diffuse Achilles tenderness and crepitus managed with load reduction and anti-inflammatory treatment.
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