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Achilles Tendinopathy and Bursitis N038

Last amended 
4 April 2016

Current RMA Instruments:

Reasonable Hypothesis SOP
96 of 2015
Balance of Probabilities SOP
97 of 2015
Changes from Previous Instruments:

SOP Bulletin 185

ICD coding:

ICD-9-CM:       726.71

ICD-10-AM:    M76.6

Brief description:

This SOP convers the two related but separate pathologies of Achilles tendinopathy and Achilles bursitis.

Achilles tendinopathy is a disease of the Achilles tendon which is behind the ankle joining the heel (calcaneus bone) to the triceps sura muscle (gastrocnemius and soleus muscles of the calf). The disease can be an inflammation (Achilles tendinitis) or a degeneration (Achilles tendinosis) and can also include tears, providing the tears are degenerative in nature and not traumatic.

Achilles bursitis is more complex since there are two possible bursae being:

  • Deep to the Achilles tendon – covered by this SOP.

  • Superficial to the Achilles tendon – not covered by this SOP but by the ‘Heel bursitis’ SOP.

A bursa is a fluid filled sac which usually occurs between a tendon and a bony structure to ease the movement of the tendon across the bone.

Confirming the diagnosis:

To confirm the diagnosis there needs to be evidence of clinical symptoms AND signs. It may be confirmed by ultrasound.

The relevant medical specialist is an orthopaedic surgeon or sports physician.

Additional diagnoses covered by these SOPs
  • Achilles tendonitis

  • Achilles tendinosis

  • Achilles tendon degenerative tear

  • Achilles bursitis if involving the deep bursa

Conditions not covered by these SOPs   

  • Superficial heel bursitis* - Heel bursitis

  • Acute Achilles tendon rupture* - Sprain and strain

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

The clinical onset is the earliest time prior to the confirmation of the disease, that a set of symptoms and signs consistent with the diagnosis could be documented. 

Clinical worsening

When considering any issues concerning possible clinical worsening, it is important to ascertain whether the clinical worsening is out of keeping with the natural history of the underlying pathology.

Achilles tendinopathy has a tendency to be episodic.