Achilles Tendinopathy in Athletes: Risk, Factors, Diagnosis, Treatment and Prevention. A Perspective of Recent Literature

Abstract

Achilles tendinopathy is one of the most common overuse injuries in athletes, often leading to persistent symptoms, reduced performance, and a high risk of recurrence. This narrative review summarizes current evidence on the risk factors, diagnosis, treatment, and prevention of Achilles tendinopathy in athletic populations. Available evidence indicates that the condition is multifactorial, with risk influenced by previous tendon symptoms, abrupt changes in training load, deficits in calf muscle function, biomechanical characteristics, age, body composition, metabolic factors, and sport-specific loading demands. Diagnosis remains primarily clinical and should distinguish between midportion and insertional tendinopathy, whereas imaging is reserved for cases with diagnostic uncertainty, persistent symptoms, or suspected alternative pathology. Progressive tendon-loading exercise remains the cornerstone of management and should be integrated with patient education, symptom-guided load progression, and a structured return-to-sport program. Adjunctive interventions may be considered in selected cases, although evidence supporting many passive treatment modalities remains limited or inconsistent. Effective management requires an individualized, load-based approach aimed at restoring tendon capacity while addressing modifiable intrinsic and extrinsic risk factors. Preventive strategies should emphasize progressive strengthening, appropriate training-load progression, and early recognition of recurrent symptoms. Further high-quality prospective studies are needed to improve risk stratification and optimize prevention and treatment strategies for athletes.