The strongest and largest tendon in the body, formed by the gastrocnemius and soleus, inserting on the calcaneus. It stores and releases elastic energy during running and jumping.
Mid-portion tendinopathy is the most common running injury. The watershed zone 2–6 cm above insertion has reduced vascularity. Heavy slow resistance exercises (Alfredson protocol) have the strongest evidence base.
Degenerative mid-portion changes from overloading, producing morning stiffness and activity-related pain — managed with progressive loading over 12+ weeks.
Complete failure 2–6 cm proximal to insertion producing a pop, inability to plantarflex against gravity, and positive Thompson test.
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