Sports Medicine

, Volume 18, Issue 3, pp 173–201 | Cite as

Achilles Tendon Injuries in Athletes

  • Martti Kvist
Review Article

Summary

Two-thirds of Achilles tendon injuries in competitive athletes are paratenonitis and one-fifth are insertional complaints (bursitis and insertion tendinitis). The remaining afflictions consist of pain syndromes of the myotendineal junction and tendinopathies. The majority of Achilles tendon injuries from sport occur in males, mainly because of their higher rates of participation in sport, but also with tendinopathies a gender difference is probably indicated. Athletes in running sports have a high incidence of Achilles tendon overuse injuries. About 75% of total and the majority of partial tendon ruptures are related to sports activities usually involving abrupt repetitive jumping and sprinting movements. Mechanical factors and a sedentary lifestyle play a role in the pathology of these injuries. Achilles tendon overuse injuries occur at a higher rate in older athletes than most other typical overuse injuries. Recreational athletes with a complete Achilles tendon rupture are about 15 years younger than those with other spontaneous tendon ruptures.

Following surgery, about 70 to 90% of athletes have a successful comeback after Achilles tendon injury. Surgery is required in about 25% of athletes with Achilles tendon overuse injuries and the frequency of surgery increases with patient age and duration of symptoms as well as occurrence of tendinopathic changes. However, about 20% of injured athletes require a re-operation for Achilles tendon overuse injuries, and about 3 to 5% are compelled to abandon their sports career because of these injuries. Myotendineal junction pain should be treated conservatively. Partial Achilles tendon ruptures are primarily treated conservatively, although the best treatment method of chronic partial rupture seems to be surgery. Complete Achilles tendon ruptures of athletes are treated surgically, because this increases the likelihood of athletes reaching preinjury activity levels and minimises the risk of re-ruptures.

Marked forefoot varus is found in athletes with Achilles tendon overuse injuries, reflecting the predisposing role of ankle joint overpronation. Athletes with the major stress in lower extremities have often a limited range of motion in the passive dorsiflexion of the ankle joint and total subtalar joint mobility, which seems to be a predisposing factor for these injuries. Various predisposing transient factors are found in about one-third of athletes with Achilles tendon overuse injuries; of these, traumatic factors (mostly minor injuries) predominate.

The typical histological features of chronically inflamed paratendineal tissue of the Achilles tendon are profound proliferation of loose, immature connective tissue and marked obliterative and degenerative alterations in the blood vessels. These changes cause continuing leakage of plasma proteins, which may have an important role in the pathophysiology of these injuries. The chronically inflamed paratendineal tissues of the Achilles tendon do not seem to have enough capacity to form mature connective tissue.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Morford M, Lenardon RJ. Classical mythology. New York: Longman Inc., 1985: 3329–35Google Scholar
  2. 2.
    Kvist M. Achilles tendon injuries in athletes. Ann Chir Gynaecol 1991; 80: 188–201PubMedGoogle Scholar
  3. 3.
    Brubaker CE, James SL. Injuries to runners. J Sports Med 1974; 2: 189–98PubMedCrossRefGoogle Scholar
  4. 4.
    Williams JGP. Studies in the aetiology, pathology, different diagnosis and management of common overuse injuries in sports [thesis]. University of Cambridge, 1983Google Scholar
  5. 5.
    Jacobs SJ, Berson BL. Injuries to runners: a study of entrants to a 10,000 meter race. Am J Sports Med 1986; 14: 151–5PubMedCrossRefGoogle Scholar
  6. 6.
    Marti B, Vader JP, Minder CE, et al. On the epidemiology of running injuries. The 1984 Bern Grand-Prix study. Am J Sports Med 1988; 16: 285–94PubMedCrossRefGoogle Scholar
  7. 7.
    Conrad CC. The President’s council on physical fitness and sports. Am J Sports Med 1981; 9: 199–202PubMedCrossRefGoogle Scholar
  8. 8.
    Johansson C. Injuries in elite orienteers. Am J Sports Med 1986; 14:410–52PubMedCrossRefGoogle Scholar
  9. 9.
    Lysholm J, Wiklander J. Injuries in runners. Am J Sports Med 1987; 15: 168–71PubMedCrossRefGoogle Scholar
  10. 10.
    Barfred T. Achilles tendon rupture. Aetiology and pathogenesis of subcutaneous rupture assessed on the basis of the literature and rupture experiments on rats. Acta Orthop Scand 1973; Suppl. 152: 1–124Google Scholar
  11. 11.
    Holz U, Ascherl I. Die Achillessehnen — Ruptur und Achillodynie. Zur Bedeutung der Gewebsregeneration. Fortsch Med 1980; 98: 1517–20Google Scholar
  12. 12.
    Nillius SA, Nilsson BE, Westlin NE. The incidence of Achilles tendon rupture. Acta Orthop Scand 1976; 47: 118–21PubMedCrossRefGoogle Scholar
  13. 13.
    Józsa L, Kvist M, Balint BJ, et al. The role of recreational sports activity in Achilles tendon rupture. A clinical, pathoanatomical, and sociological study of 292 cases. Am J Sports Med 1989; 17: 338–43PubMedCrossRefGoogle Scholar
  14. 14.
    Schönbauer HR. Erkrankungen der Achillessehne. Wien Klin Wschr 1986; 98 Suppl. 168: 3–47Google Scholar
  15. 15.
    Zollinger H, Rodriquez M, Genoni M. Zür Ätiopathogenese und Diagnostik der Achillessehnenrupturen im Sport. In Chapchal G, editor. Sportverletzung und Sportschaden. Stuttgart: Georg Thieme, 1983: 75–7Google Scholar
  16. 16.
    Puddu G, Ippolito E, Postacchini F. A classification of Achilles tendon disease. Am J Sports Med 4: 1976; 146–50CrossRefGoogle Scholar
  17. 17.
    Santilli G. Achilles tendinopathies and paratendinopathies. J Sports Med 1979; 19: 245–59Google Scholar
  18. 18.
    Dorland’s Illustrated Medical Dictionary, 25th edition. Philadelphia: Saunders, 1974: 1131, 1515Google Scholar
  19. 19.
    Kurppa K, Waris P, Rokkanen P. Peritendinitis and tenosynovitis. A review. Scand J Work Environ Health 1979; 5 Suppl. 3: 19–24PubMedCrossRefGoogle Scholar
  20. 20.
    Albertini A. Spezielle Pathologie der Sehnen, Sehnenscheiden und Schleimbeutel. Handbuch der speziellen Anatomie und Histologie IX. Berlin: Springer, 1929: 511–27, 545–52Google Scholar
  21. 21.
    Howard NJ. A new concept of tenosynovitis and the pathology of physiologic effort. Am J Surg 1938; 62: 723–30CrossRefGoogle Scholar
  22. 22.
    Rais O. Heparin treatment of peritenomyosis (peritendinitis) crepitans acuta. A clinical and experimental study including the morphological changes in peritenon and muscle. Acta Chir Scand 1961; Suppl. 268: 1–88Google Scholar
  23. 23.
    Biehl G, Harms J. Behandlung der Paratenonitis achillaea bei Hochleistungssportlern. I. Arch Orthop Unfall Chir 1977; 87: 309–15CrossRefGoogle Scholar
  24. 24.
    Kvist H, Kvist M. The operative treatment of chronic calcaneal paratenonitis. J Bone Joint Surg 1980; 62-B: 353–7Google Scholar
  25. 25.
    Galloway MT, Jokl P, Dayton OW. Achilles tendon overuse injuries. Clinics Sports Med 1992; 11: 771–82Google Scholar
  26. 26.
    Clancy WG, Neidhart D. Brand RL. Achilles tendonitis in runners: a report of five cases. Am J Sports Med 1976; 4: 46–57PubMedCrossRefGoogle Scholar
  27. 27.
    Aronson NG, Winston L, Cohen RI, et al. Some aspects of problems in runners. Treatment and prevention. J Am Podiatry Assoc 1977; 67: 595–6PubMedGoogle Scholar
  28. 28.
    Leach RE, James S, Wasilewski S. Achilles tendinis. Am J Sports Med 1981; 9: 93–8PubMedCrossRefGoogle Scholar
  29. 29.
    Williams JGP. Achilles tendon lesions in sport. Sports Med 1986; 3: 114–35PubMedCrossRefGoogle Scholar
  30. 30.
    Schmitgen G, Haasters J. Bei ‘Achillodynie’ auch an seltene Ursachen denken — Ein Fallbericht liber ein Schwannom des Nervus Tibialis. Sportverl Sportschad 1990; 4: 45–7CrossRefGoogle Scholar
  31. 31.
    Haglund P. Remarks about fractures of the calcaneal epiphysis and similar juvenile injuries of diaphysis. German Arch Clin Surg 1907; 82: 922Google Scholar
  32. 32.
    Fowler A, Philip JF. Abnormality of the calcaneus as a cause of painful heel. Its diagnosis and operative treatment. Br J Surg 1945; 32: 494–8CrossRefGoogle Scholar
  33. 33.
    Vega MR, Cavolo DJ, Green RM, et al. Haglund’s deformity. J Am Podiatr Assoc 1984; 74: 129–35Google Scholar
  34. 34.
    Pavlov H, Heneghan MA, Hersh A, et al. The Haglund Syndrome: initial and differential diagnosis. Radiology 1982; 144: 83–8PubMedGoogle Scholar
  35. 35.
    Curvin S, Stanish WD. Tendinitis: its etiology and treatment (ISBN 0-669-07394-6). Lexington: Collamore Press, DC Heath & Co, 1984Google Scholar
  36. 36.
    Alexander RMcN, Bennet-Clarke HC. Storage of elastic strain energy in muscle and other tissues. Nature 265: 114–7, 1977PubMedCrossRefGoogle Scholar
  37. 37.
    Edwards DAW. The blood supply and lymphatic drainage of tendon. J Anat 1946; 80: 147–52Google Scholar
  38. 38.
    Trotter JA, Baca JM. A stereological comparison of the muscle-tendon junction of tast and slow fibers in chicken. Anat Rec 1987; 218: 256–66PubMedCrossRefGoogle Scholar
  39. 39.
    Kvist M, Józsa L, Kannus P, et al. Morphology and histochemistry of the myotendineal junction of the rat calf muscles. Histochemical, immunohistochemical and electron microscopic study. Acta Anatomica 1991; 141: 199–205PubMedCrossRefGoogle Scholar
  40. 40.
    Tidball JG. Myotendinous junction injury in relation to junction structure and molecular composition. Exerc Sport Sci Rev 1991; 19:419–45PubMedCrossRefGoogle Scholar
  41. 41.
    Cummins EJ, Anson BJ, Carr BW, et al. The structure of calcaneal tendon (of Achilles) in relation to orthopaedic surgery. With additional observations on the plantaris muscle. Surg Gynecol Obstet 83: 1946; 107–16PubMedGoogle Scholar
  42. 42.
    Smart GW, Taunton JE, Clement DB. Achilles tendon disorders in runners — a review. Med Sci Sports Exerc 1980; 12: 231–43PubMedGoogle Scholar
  43. 43.
    O’Brien. Functional anatomy and physiology of tendons. Clin Sports Med 1992; 11:505–20Google Scholar
  44. 44.
    Wahrenberg H, Lundbeck L, Ekholm J. Knee. Dynamic load in human knee during voluntary active impact to lower leg. Scand J Rehab Med 1978; 10: 93–8Google Scholar
  45. 45.
    Komi PV, Fukashiro S, Järvinen M. Biomechanical loading of achilles tendon during normal locomotion. Clin Sports Med 1992; 11:521–31PubMedGoogle Scholar
  46. 46.
    Lang J. Über das Verschiebegewebe der Achillessehne. Anat Anz 1960; 108: 225–37PubMedGoogle Scholar
  47. 47.
    Benjamin M, Evans EJ, Copp L. The histology of tendon attachments to bone in man. J Anat 1986; 149: 89–100PubMedGoogle Scholar
  48. 48.
    Carr AJ, Norris SH. The blood supply of the calcaneal tendon. J Bone Joint Surg 1989; 71-B: 100–1Google Scholar
  49. 49.
    Naito M, Ogata K. The blood supply of the tendon with a paratenon. An experimental study using hydrogen washout technique. Hand 1983; 15: 9–14PubMedCrossRefGoogle Scholar
  50. 50.
    Tipton CM, Matthes RD, Maynard JA, et al. The influence of physical activity on ligaments and tendons. Med Sci Sports Exerc 1975; 7: 165–74Google Scholar
  51. 51.
    Dahmen G. Elektronmikroskopische Beobachtungen bei degenerierten Sehnen. Arch Orthop Unfall Chir 1962; 54: 126–38CrossRefGoogle Scholar
  52. 52.
    Vailas M, Tipton CM, Langhlin HL, et al. Physical activity and hypophysectomy on the aerobic capacity of ligaments and tendons. J Appl Physiol 1978; 44: 542–46PubMedGoogle Scholar
  53. 53.
    Woo SL, Gomez MA, Woo YK, et al. Mechanical properties of tendons and ligaments: II. The relationship between immobilization and exercise on tissue remodelling. Biorheology 1982; 19: 397–408PubMedGoogle Scholar
  54. 54.
    Tipton CM, Vailas AC, Matthes RD. Experimental studies on the influence of physical activity on ligaments, tendons and joints: a brief review. Acta Med Scand 1986; Suppl. 711: 157–68Google Scholar
  55. 55.
    Karpakka J. Effects of physical activity and inactivity on collagen synthesis in rat skeletal muscle and tendon. Thesis. Acta Universitas Ouluensis. Series D, Medica 231. Oulu: Oulo University, 1991Google Scholar
  56. 56.
    Rothman RH, Slogoff S. The effect of immobilization on the vascular bed of tendon. Surg Gynecol Obstet 1967; 124: 1064–66PubMedGoogle Scholar
  57. 57.
    Tipton CM, Matthes RD, Vailas AC, et al. Lesions and connective tissue. In: Staff PH, editor. Proceedings of the Nordisk Idrettsmedisinsk Kongress. Beitostolen: 1977; 67–80Google Scholar
  58. 58.
    Binkley JM, Peat M. The effects of immobilization on the ultrastructure and mechanical properties of the collateral ligament of rats. Clin Orthop Scand 1973; Suppl. 152: 74–98Google Scholar
  59. 59.
    Nakagawa Y, Totsuka M, Sato T, et al. Effect of disuse on the ultrastructure of the achilles tendon in rats. Eur J Appl Physiol 1989; 59: 239–42CrossRefGoogle Scholar
  60. 60.
    Gamble JG, Edwards CC, Max SR. Enzymatic adaptations in ligaments during immobilization. Am J Sports Med 1984; 12: 221–8PubMedCrossRefGoogle Scholar
  61. 61.
    Vailas AC, Tipton CM, Matthes RD, et al. Physical activity and its influence on the repair process of medial collateral ligaments. Connect Tissue Res 1981; 9: 25–31PubMedCrossRefGoogle Scholar
  62. 62.
    Savolainen J, Myllyla V, Myllyla R et al. Effects of denervation and immobilization on collagen synthesis in rat skeletal muscle and tendon. Am J Physiol 1988; 254: R897–R902PubMedGoogle Scholar
  63. 63.
    Karpakka J, Palokangas H, Virtanen P, et al. The effects of immobilization on the biosynthesis and quality of Achilles tendon in rats. In: Hermans GPH, Mosterd GL, editors. Sports medicine and health. Proceedings of the XXIV World Congress of Sports Medicine, Amsterdam, 1990. Amsterdam: Excerpta Medica, 1990: 248–56Google Scholar
  64. 64.
    Kannus P, Józsa L, Renström P, et al. The effects of training, immobilisation and remobilisation on musculoskeletal tissues. Part I. Training and immobilisation. Scand J Med Sci Sports 2: 1992; 100–18CrossRefGoogle Scholar
  65. 65.
    Shadwick RE. Elastic energy storage in tendons: mechanical differences related to function and age. J Appl Physiol 1990; 68: 1033–40PubMedCrossRefGoogle Scholar
  66. 66.
    Suominen H, Kiiskinen A, Heikkinen E. Effect of physical training on metabolism of connective tissue in young mice. Acta Physiol Scand 1980; 108: 17–22PubMedCrossRefGoogle Scholar
  67. 67.
    Michna H, Hartman G. Adaptation of tendon to exercise. Int Orthop 1989; 13: 161–5PubMedCrossRefGoogle Scholar
  68. 68.
    Ingelmark BE. Über den Bau des Sehnen unter verschiedenen funktionellen Bedingungen. Uppsala Lakarforenings Forhandlingar 1945; 50: 357–80Google Scholar
  69. 69.
    Viidik A. The effect of training on the tensile strength of isolated rabbit tendons. Scand J Plast Reconstr Surg 1967; 1: 141–7PubMedCrossRefGoogle Scholar
  70. 70.
    Curvin SL, Vailas AC, Wood J. Immature tendon adaptation to strenuous exercise, J Appl Physiol 1988; 65 (5): 2297–301Google Scholar
  71. 71.
    Takemiyah T, Maeda J-I. The functional characteristivcs of tendon blood circulation in the rabbit hindlimbs. Jpn J Physiol 1988; 38: 361–74CrossRefGoogle Scholar
  72. 72.
    Renström P, Johnson FJ. Overuse injuries. Sports Med 1985; 2: 316–23PubMedCrossRefGoogle Scholar
  73. 73.
    Clement DB, Taunton JE, Smart GW. Achilles tendinitis and peritendinitis: etiology and treatment. Am J Sports Med 1984; 12: 179–84PubMedCrossRefGoogle Scholar
  74. 74.
    Brenke H, Jungmichel D, Dietrich L, et al. Zur Prophylaxe und Rehabilitation der Achillodynie aus sportmethodischer Sicht. Med Sport 1979; 19: 337–41Google Scholar
  75. 75.
    Howard NJ. Peritendinitis crepitans. A muscle-effort syndrome. J Bone Joint Surg 1937; 14: 447–59Google Scholar
  76. 76.
    Thompson AR, Plewes LW, Shaw EG. Peritendinitis crepitans and simple tenosynovitis: a clinical study of 544 cases in industry. Br J Ind Med 1951; 8: 150–60PubMedGoogle Scholar
  77. 77.
    Orava S. Exertion injuries due to sports and physical exercise. A clinical and statistical study of nontraumatic overuse injuries of the musculoskeletal system of athletes and keep fit athletes. Dissertion. Oulu: University of Oulu, 1980Google Scholar
  78. 78.
    Kvist M, Järvinen M. Clinical, histochemical and biomechanical features in repair of muscle and tendon injuries. Int J Sports Med 1982; 3: 12–4PubMedCrossRefGoogle Scholar
  79. 79.
    Sedgwick AW, Smith DS, Davies MJ. Musculoskeletal status of men and women who entered a fitness programme. Med J Aust 1988; 148: 385–91PubMedGoogle Scholar
  80. 80.
    Kvist M. Achilles tendon overuse injuries in athletes. A clinical and pathophysiological study with special reference to Achilles paratenonitis. Ann Universitatis Turkuensis Ser D 1991; 87: 1–122Google Scholar
  81. 81.
    Powell KE, Kohl HW, Caspersen CJ, et al. An epidemiological perspective on the causes of running injuries. Physician Sportsmed 1986; 14: 100–14Google Scholar
  82. 82.
    Brody DM. Running injuries. Prevention and management. Clin Symp 1987; 39: 1–36PubMedGoogle Scholar
  83. 83.
    James SL, Bates BT, Osternig LR. Injuries to runners. Am J Sports Med 1978; 6: 40–50PubMedCrossRefGoogle Scholar
  84. 84.
    Clancy Jr WG. Tendinitis and plantar fasciitis in runners. In: D’Ambrosia R, Drez Jr D, editors. Prevention and treatment of running injuries (ISBN 0-913590-86-X). New Jersey: Charles B Slack, Inc., 1982Google Scholar
  85. 85.
    Clement DB, Taunton JE, Smart GW, McNicol KL. A survey of overuse running injuries. Physician Sportsmed 1981; 9: 47–58Google Scholar
  86. 86.
    Pinshaw R, Atlas V, Noakes TD. The nature and response to therapy of 196 consecutive injuries seen at a runner’s clinic. S Afr Med J 1984; 65:291–8PubMedGoogle Scholar
  87. 87.
    Leppilahti J, Orava S, Karpakka J, et al. Overdose injuries of the Achilles tendon. Ann Chir Gynaecol 1991; 80: 202–7PubMedGoogle Scholar
  88. 88.
    Pollock ML, Gettman LR, Milesis CA, et al. Effects of frequency and duration of training on attrition and incidence of injury. Med Sci Sports Exerc 1977; 9: 31–6Google Scholar
  89. 89.
    Sheehan GA. An overview of overuse syndromes in distance runners. In: The marathon: physiological, medical, epidemiological and psychological studies. Ann NY Acad Sci 1977; 301: 877–84PubMedCrossRefGoogle Scholar
  90. 90.
    Koplan JP, Powell KE, Sikes RK, et al. An epidemiologic study of the benefits and risks of running. JAMA 1382; 248: 3118–21CrossRefGoogle Scholar
  91. 91.
    Kowal DM. Nature and causes of injuries in women resulting from an endurance training program. Am J Sports Med 1980; 8: 265–9PubMedCrossRefGoogle Scholar
  92. 92.
    Subotnick SI, Sisney P. Treatment of Achilles tendinopathy in the athlete. J Am Podiatry Assoc 1986; 10: 552–7Google Scholar
  93. 93.
    Nicol C, Komi P, Marconnet P. Fatigue effects of marathon running on neuromuscular performance. I: changes in muscle force and stiffness characteristics. Scand J Med Sci Sports 1991; 1: 10–7CrossRefGoogle Scholar
  94. 94.
    Nicol C, Komi P, Marconnet P. Fatigue effects of marathon running on neuromuscular performance. II: changes in force, integrated electromyographic activity and endurance capacity. Scand J Med Sci Sports 1991; 1: 18–24CrossRefGoogle Scholar
  95. 95.
    Subotnick SI, editor. Sports medicine of the lower extremity (ISBN 0-443-08560-9). New York: Churchill Livingstone Inc., 1989Google Scholar
  96. 96.
    Kvist M, Alanen J, Levola J. Overuse injures, osteochondroses and growing pains in the lower extremities of children. Some aspects of the role of physical activity and foot structure. Sport Medische Tijdingen 1989; 10: 249–58Google Scholar
  97. 97.
    Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine 1983; 8: 643–51PubMedCrossRefGoogle Scholar
  98. 98.
    Viitasalo J, Kvist M. Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. Am J Sports Med 1983; 11: 125–30PubMedCrossRefGoogle Scholar
  99. 99.
    Kvist M, Komi PV, Hyvarinen T. Orthotic treatment, static and dynamic testing of foot-shoe deficiency. In: Kvist M, editor. Paavo Nurmi Congress book (ISBN 952-90-1266-7). Advanced European Course on Sports Medicine, 50th Anniversary of the Finnish Society of Sports Medicine. Turku: Grafia Oy, 1989; 223–9Google Scholar
  100. 100.
    Hyvarinen T. Karhu Ortix. The system of the future. Helsinki: Karhu Titan Company, 1988Google Scholar
  101. 101.
    Root ML, Orien WP, Weed JH. Normal and abnormal function of the foot. Clinical Biomechanics, Vol II. Los Angeles: Clin Biomech Corporation, 1977Google Scholar
  102. 102.
    Nigg BM. Biomechanik. Zurich: Juris Druck und Verlag, 1977Google Scholar
  103. 103.
    Segesser B, Nigg BM, Morell F. Achillodynie und tibiale Insertiotendinosen. Med Sport 1980; 20: 79–83Google Scholar
  104. 104.
    Brown LP, Yavorsky P. Locomotor biomechanics and pathomechanics: a review. J Orthop Sports Phys Ther 1987; 9: 3–10PubMedGoogle Scholar
  105. 105.
    Friberg O. Leg length asymmetry in stress fractures. A clinical and radiological study. J Sports Med 1982; 22: 485–8Google Scholar
  106. 106.
    Friberg O, Kvist M. Leg length inequality in athletes. In: Bachl N, Prokop L, Suckert R, editors. Proceedings of the World Congress of Sports Medicine, Vienna, 1982. Vienna: Urban & Schwarzenberg, 1984: 984–92Google Scholar
  107. 107.
    Friberg O, Kvist M, Aalto T, et al. Leg length inequality in the etiology of low back pain and lower limb overuse injuries in young athletes. Idrotts Medicin 1985; 5: 5–7Google Scholar
  108. 108.
    Kujala UM, Osterman K, Kvist M, et al. Factors predisposing athletes to patellar chondropathy and patellar apicitis. Int Orthop 1986; 10: 195–200PubMedCrossRefGoogle Scholar
  109. 109.
    Kujala U, Osterman K. Kvist M, et al. Factors predisposing to patellar chondropathy and patellar apicitis in athletes. Int Orthop 1986; 10: 195–200PubMedCrossRefGoogle Scholar
  110. 110.
    Leach RE, Dilorio E, Harney RA. Pathologic hindfoot conditions in the athlete. Clin Orthop 1983; 177: 116–21PubMedGoogle Scholar
  111. 111.
    Fuglsang F, Torup O. Bursitis retrocalcanearis. Acta Orthop Scand 1961; 30:315–23PubMedCrossRefGoogle Scholar
  112. 112.
    Roy S, Irvin R. Sports medicine. Prevention, evaluation, management and rehabilitation (ISBN 0-13-837807-X). Englewood Cliffs: Prentice-Hall Inc., 1983Google Scholar
  113. 113.
    Keck SW, Kelly PJ. Bursitis of the posterior part of the heel. Evaluation of surgical treatment of 18 patients. J Bone Joint Surg 1965; 47-A: 267–73Google Scholar
  114. 114.
    Fiamengo SA, Warren RF, Marshall JL, et al. Posterior heel pain associated with a calcaneal step and Achilles tendon calcification. Clin Orthop 1982; 167: 203–11PubMedGoogle Scholar
  115. 115.
    Jörgensen U. Achillodynia and loss of heel pad shock absorbency. Am J Sports Med 1985; 13: 128–32PubMedCrossRefGoogle Scholar
  116. 116.
    Frey CC, Shereff MI. Tendon injuries about the ankle in athletes. Clin Sports Med 1988; 7: 103–18PubMedGoogle Scholar
  117. 117.
    Sigerseth PO, Haliski CC. The flexibility of football players. Res Q 1950; 21: 394–8Google Scholar
  118. 118.
    Ekstrand J, Gillqvist J. The frequency of muscle tightness and injuries in soccer players. Am J Sports Med 1982; 10: 75–8PubMedCrossRefGoogle Scholar
  119. 119.
    Harris ML. Flexibility. Phys Ther 1969; 49: 591–601PubMedGoogle Scholar
  120. 120.
    Marshall JL, Johansson N, Wickiewicz TL, et al. Joint looseness: a function of the person and the joint. Med Sci Sports Exerc 1980; 12: 189–94PubMedGoogle Scholar
  121. 121.
    Bach DK, Green DS, Jensen GM, et al. A comparison of muscular tightness in runners and nonrunners and the relation of muscular tightness to low back pain in runners. J Orthop Sports Phys Ther 1985; 6: 315–23PubMedGoogle Scholar
  122. 122.
    Grimby G. Physical activity and effects of muscle training in the elderly. Ann Clin Res 1988; 20: 62–6PubMedGoogle Scholar
  123. 123.
    Pirhonen M, Komi PV, Hakkinen K, et al. Strength training and neuromuscular function in elderly people with total knee endoprosthesis. Scand J Med Sci Sports 1992; 2: 234–43Google Scholar
  124. 124.
    Liemohn WP. Strength and aging: an exploratory study. Int J Aging Hum Dev 1975; 6: 347–57PubMedCrossRefGoogle Scholar
  125. 125.
    Lysens RJ, Ostyn MS, Auweele YV, et al. The accident-prone and overuse-prone profiles of the young athlete. Am J Sports Med 1989; 17: 612–9PubMedCrossRefGoogle Scholar
  126. 126.
    Zachazewski JE, Reischl S. Flexibility for the runner: specific program considerations. Top Acute Care Trauma Rehabil 1986; 1:9–27Google Scholar
  127. 127.
    Jörgensen U. Ekstrand J. Significance of heel pad confinement for the shock absorption at heel strike. Int J Sports Med 1988; 9: 468–73PubMedCrossRefGoogle Scholar
  128. 128.
    Cavanagh PFI. The running shoe book (ISBN 0-89037-182-2). Mountain View: Anderson World, Inc., 1980Google Scholar
  129. 129.
    Nigg BM, Morlock M. The influence of lateral heel flare of running shoes on pronation and impact forces. Med Sci Sports Exerc 1987; 9: 294–302Google Scholar
  130. 130.
    Nigg B. Biomechanics. Load analyses and sports injuries in the lower extremities. Sports Med 1985; 2: 367–79PubMedCrossRefGoogle Scholar
  131. 131.
    Dickinson PH, Coutts MB, Woodward EP, et al. Tendon Achilles bursitis. Report of twenty-one cases. J Bone Joint Surg 1966; 48-A: 77–81Google Scholar
  132. 132.
    Kannus P, Niittymäki S. Järvinen M, et al. Sports injuries in elderly athletes: a three-year prospective, controlled study. Age Ageing 1989; 18: 203–70CrossRefGoogle Scholar
  133. 133.
    Kramer J, Schmitz-Beuting J. Überbelastungsschaden am Bewegungsapparat bei Tennisspielern. Dtsch Z Sportmed 1979; 30: 44–8Google Scholar
  134. 134.
    Kvist M, Heinonen O. Calcaneal acophysitis (Sever’s disease) — a common cause of heel pain in young athletes. Scand J Med Sci Sports 1991; 1:235–8CrossRefGoogle Scholar
  135. 135.
    Hastad K, Larsson L-G, Lindholm A. Clearance of radiosodium after local deposit in the achilles tendon. Acta Chir Scand 1958-1959; 116: 251–5Google Scholar
  136. 136.
    Niculescu V, Matusz P. The clinical importance of the calcaneal tendon vasculature (tendo calcaneus). Morphol Embryol 1988; 34: 5–8Google Scholar
  137. 137.
    Brocklehurst JC. Textbook of geriatric medicine and gerontology. Edinburgh: Churchill Livingstone, 1985; 46–50Google Scholar
  138. 138.
    Kannus P, Niittymäki S, Järvinen M. Sports injuries in women: a one-year prospective follow-up study at an outpatient sports clinic. Br J Sports Med 1987; 21: 37–9PubMedCrossRefGoogle Scholar
  139. 139.
    Valliant PM. Personality and injury in competitive runners. Percept Motor Skills 1981; 53: 251–3PubMedCrossRefGoogle Scholar
  140. 140.
    Pagliano J, Jackson D. The ultimate study of running injuries. Runners World 1980; 42–50Google Scholar
  141. 141.
    Taimela S, Kujala U, Osterman K. Stress injury progress: a prospective study during a physical training program. Int J Sports Med 11: 1990; 162–5PubMedCrossRefGoogle Scholar
  142. 142.
    Hess H, Hort W. Erhöhte Verletzungsgefahr beim Leichtathletiktraining auf Kunststoffboden. Sportartz Sportmed 1973; 24: 282–5Google Scholar
  143. 143.
    Gross D. Einfuhrung in die Problematik der Insertiotendinosen. Schweiz Z Sportmed 1987; 35: 59–62PubMedGoogle Scholar
  144. 144.
    Ekstrand J, Nigg BM. Surface-related injuries in soccer. Sports Med 1989; 8: 56–62PubMedCrossRefGoogle Scholar
  145. 145.
    Schuster B. Foot types and the influence of environment on the foot of the long distance runner. In: The marathon: physiological, medical, epidemiological and psychological studies. Ann NY Acad Sci 1977, 301: 881–7PubMedCrossRefGoogle Scholar
  146. 146.
    Malt U, Myhrer T, Blikra G, et al. Psychopathology and accidental injuries. Acta Psychiatr Scand 1987; 76: 261–71PubMedCrossRefGoogle Scholar
  147. 147.
    Taimela S. Individual-related characteristics and musculoskeletal injuries with special reference to reaction time, mental ability and psychological factors [thesis]. Annales Universitatis Turkuensis, Ser. D. 1991; 85: 1–58Google Scholar
  148. 148.
    Taimela S, Osterman K, Kujala U, et al. Motor ability and personality with reference to soccer injuries. J Sports Med Phys Fitness 1990; 30: 194–201PubMedGoogle Scholar
  149. 149.
    Kerr G, Fowler B. The relationship between psychological factors and sports injuries. Sports Med 1988; 6: 127–34PubMedCrossRefGoogle Scholar
  150. 150.
    Shapiro JR, Fallat RW, Tsang RC, et al. Achilles tendinitis and tenosynovitis. A diagnostic manifestation of familial type II hyperlipoproteinemia in children. Am J Dis Child 1974; 128: 486–90PubMedGoogle Scholar
  151. 151.
    Gerster JC, Vischer TL, Bennani A, et al. The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter’s syndrome and generalized osteoarthrosis. Ann Rheum Dis 1977; 36: 343–8PubMedCrossRefGoogle Scholar
  152. 152.
    Kujala U, Järvinen M, Natri A, et al. ABO blood groups and musculoskeletal injuries. Injury 1992; 23: 131–3PubMedCrossRefGoogle Scholar
  153. 153.
    Olivieri I, Gemignani G, Gherardi S, et al. Isolated HLA-B 27 associated Achilles tendinitis. Ann Rheum Dis 1987; 46: 626–7PubMedCrossRefGoogle Scholar
  154. 154.
    Landvater SJ, Renström AFH. Complete Achilles tendon ruptures. Clin Sports Med 1992; 11: 741–58PubMedGoogle Scholar
  155. 155.
    Inglis AE, Sculco TP. Surgical repair of ruptures of the tendo achilles. Clin Orthop 1981; 156: 160–9PubMedGoogle Scholar
  156. 156.
    Józsa L, Reffy A, Kannus P, et al. Pathological alterations in human tendons. Arch Orthop Trauma Surg 1990; 110: 15–21PubMedCrossRefGoogle Scholar
  157. 157.
    Blazina ME, Kerlan RK, Jobe FW, et al. Jumper’s knee. Orthop Clin North Am 1973; 4: 665–78PubMedGoogle Scholar
  158. 158.
    Komi PV, Salonen M, Järvinen M, et al. In vivo registration of Achilles tendon forces in man. Int J Sports Med 1987; 8 Suppl. 1: 3–8PubMedCrossRefGoogle Scholar
  159. 159.
    Becker W, Krahl H. Die Tendinopathien. Grundlagen, Klinik, Therapie (ISBN 3-13-554601-2). Stuttgart: Georg Thieme Verlag, 1978Google Scholar
  160. 160.
    Borsay J, Csipak J, Dettre G. Experimentelle Beitrage zur Frage der Tendolipoidose. Z Orthop 81: 1952; 545–51PubMedGoogle Scholar
  161. 161.
    Kannus P, Józsa L, Renström P, et al. The effects of training, immobilisation and remobilisation on musculoskeletal tissues. Part II. Remobilisation, and remobilisation and prevention of immobilization atrophy. Scand J Med Sci Sports 1992; 2: 164–77CrossRefGoogle Scholar
  162. 162.
    Józsa L, Kannus P, Järvinen M, et al. Denervation and immobilization induced changes in the myotendinous junction. A comparative histological, histochemical and immunohistochemical study on the muscle-tendon units of humans and rats. Eur J Exp Musculoskel Res 1992; 1: 105–12Google Scholar
  163. 163.
    Amer O, Lindholm A. Subcutaneous rupture of the Achilles tendon: a study of 92 cases. Acta Chir Scand 1959; Suppl. 239: 1–51Google Scholar
  164. 164.
    Schnorrenberg G. Über die Gefassversorgung der Achillessehne. Gegenbaurs Morphol Jahrb 1962; 103: 428–56Google Scholar
  165. 165.
    Amer O, Lindholm A, Orell SR. Histologic changes in subcutaneous rupture of the Achilles tendon. A study of 74 cases. Acta Chir Scand 1958-1959; 116: 484–90Google Scholar
  166. 166.
    Wilhelm K. Die statische und dynamische Belastbarken der Achillessehne. Res Exp Med 1972; 157: 221–3CrossRefGoogle Scholar
  167. 167.
    Denstad TF, Roaas A. Surgical treatment of partial Achilles tendon ruptures. Am J Sports Med 1979; 7: 15–17PubMedCrossRefGoogle Scholar
  168. 168.
    Skeoch DU. Spontaneous partial subcutaneous rupture of the tendo achilles. Review of the literature and evaluation of 16 involved tendons. Am J Sports Med 1981; 9: 20–2PubMedCrossRefGoogle Scholar
  169. 169.
    Ljungqvist R. Subcutaneous partial rupture of the Achilles tendon. Acta Orthop Scand. 1968; Suppl. 113: 1–86Google Scholar
  170. 170.
    Hattrup SJ, Johnson KA. A review of ruptures of the Achilles tendon. Foot Ankle 1985; 6: 34–8PubMedGoogle Scholar
  171. 171.
    Nada A. The use of ultrasonography in the diagnosis of partial rupture of the Achilles tendon and its muscular attachment. In: Hermans GPH, Mosterd GL, editors. Sports medicine and health. Proceedings of the XXIV World Congress of Sports Medicine, Amsterdam, Amsterdam: Excerpta Medica, 1990: 224–47Google Scholar
  172. 172.
    Gillström P, Ljungqvist R. Long-term results after operation for subcutaneous partial rupture of the Achilles tendon. Acta Chir Scand 1978; Suppl. 482: 78Google Scholar
  173. 173.
    Michna H. Tendon injures induced by exercise and anabolic steroids in experimental mice. Int Orthop 1987; 11: 157–62PubMedCrossRefGoogle Scholar
  174. 174.
    Harms J, Biehl G, von Hochbach G. Pathologie der Paratenonitis Achillaea bei Hochleistungssportlem II. Arch Orthop Unfall Chir 1977; 88: 65–74Google Scholar
  175. 175.
    Kvist M, Józsa L, Järvinen M, et al. Fine structural alterations in chronic achilles paratenonitis in athletes. Path Res Pract 1985; 180:416–23PubMedCrossRefGoogle Scholar
  176. 176.
    Kvist M, Józsa L, Järvinen M, et al. Chronic Achilles paratenonitis in athletes: a histological and histochemical study. Pathology 1987; 19: 1–11PubMedCrossRefGoogle Scholar
  177. 177.
    Kvist M, Lehto M, Józsa L, et al. Chronic Achilles paratenonitis. An immunohistologic study of fibronectin and fibrinogen. Am J Sports Med 1988; 16: 616–23PubMedCrossRefGoogle Scholar
  178. 178.
    Gerdin B, Saldeen T. Effect of fibrin degradation products on microvascular permeability. Thromb Res 1978; 13: 995–1006PubMedCrossRefGoogle Scholar
  179. 179.
    Rowland FN, Donovan MJ, Picciano PT, et al. Fibrin-mediated vascular injury. Identification of fibrin peptides that mediate endothelial cell retraction. Am J Pathol 1984; 117: 418–28PubMedGoogle Scholar
  180. 180.
    Senior RM, Skogen WF, Griffin GL, et al. Effects of fibrinogen derivatives upon the inflammatory response. Studies with human fibrinopeptide B. J Clin Invest 1986; 77: 1014–9PubMedCrossRefGoogle Scholar
  181. 181.
    Merkel KHH, Hess H, Kunz M. Insertion tendopathy in athletes. A light microscopic, histochemical and electron microscopic examination. Pathol Res Pract 1982; 173: 303–9PubMedCrossRefGoogle Scholar
  182. 182.
    Dahmen G. Altenungs- und Degeneratonsveränderungen des Bindegewebes in ihrer Bedeutung für die Klinik. Z Rheumfrsch 1964; 23: 390–405Google Scholar
  183. 183.
    Józsa L, Reffy A, Balint JB. Feinstructurelle Veränderungen bei degenerativer Tendinopathie. Zentralbl Allg Pathol 1986; 131:429–35PubMedGoogle Scholar
  184. 184.
    Kvist M, Józsa L, Järvinen M. Vascular alterations in the ruptures Achilles tendon and its paratenon. Int Orthop 1992; 16: 377–82PubMedCrossRefGoogle Scholar
  185. 185.
    Perugia L, Pollini PTR, Ippolito E. Ultrastructural aspects of degenerative tendinopathy. Int Orthop 1978; 1: 303–7CrossRefGoogle Scholar
  186. 186.
    Józsa L, Balint BJ, Reffy A, et al. Hypoxic alterations of tenocytes in degenerative tendinopathy. Acta Orthop Trauma Surg 1982; 99: 243–6CrossRefGoogle Scholar
  187. 187.
    Lehto M, Józsa L, Kvist M, et al. Fibronectin in ruptured human Achilles tendon and its paratenon. An immunoperoxidase study. Ann Chir Gyn 1990; 79: 72–7Google Scholar
  188. 188.
    Józsa L, Balint BJ, Reffy A, et al. Fine structural alterations of collagen fibers in degenerative tendinopathy. Acta Orthop Trauma Surg 1984; 103: 47–52CrossRefGoogle Scholar
  189. 189.
    Józsa L, Lehto M, Kvist M, et al. Alterations in dry mass content of collagen fibers in degenerative tendinopathy and tendon rupture. Matrix 1989; 9: 140–6PubMedCrossRefGoogle Scholar
  190. 190.
    Millar AP. Strains of the posterior calf musculature (‘tennis leg’). Am J Sports Med 1979; 7: 172–4PubMedCrossRefGoogle Scholar
  191. 191.
    McClure JG. Gastrocnemius musculotendinous rupture: a condition confused with thrombophlebitis. South Med J 1984; 77: 1143–5PubMedCrossRefGoogle Scholar
  192. 192.
    Christensen I. Rupture of the Achilles tendon: analysis of 57 cases. Acta Chir Scand 1953-1954; 106: 50–60PubMedGoogle Scholar
  193. 193.
    Thompson TC, Doherty JH. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. J Trauma 2: 1962; 126–9PubMedCrossRefGoogle Scholar
  194. 194.
    von Saar G. Die Sportverletzungen. Neue deutsche Chirurgie. Stuttgart: Ferdinand Enke, 1914Google Scholar
  195. 195.
    Kager H. Zur Klinik und Diagnostik der Achillessehnenrisses. Chirurgie 1939; 19: 691–694Google Scholar
  196. 196.
    Gerster JC, Hauser H, Fallet GH. Xeroradiographic techniques applied to assessment of Achilles tendon in inflammatory or metabolic diseases. Ann Rheum Dis 1975; 34: 479–88PubMedCrossRefGoogle Scholar
  197. 197.
    Burhenne LJW, Connell, DG. Xeroradiography in the diagnosis of the Haglund syndrome. J Can Assoc Radiol 1986; 37: 157–60Google Scholar
  198. 198.
    Mäkelä P. Studies on soft tissue radiography of the hands in rheumatoid arteritis [thesis]. Turku: University of Turku, 1978Google Scholar
  199. 199.
    Laine HR, Harjula ALJ, Peltokallio P. Ultrasonography as a differential diagnostic aid in achillodynia. J Ultrasound Med 1987; 6: 351–62PubMedGoogle Scholar
  200. 200.
    Maffulli N, Regine R, Angelillo M, et al. Ultrasound diagnosis of Achilles tendon pathology in runners. Br J Sports Med 1987; 21: 168–2CrossRefGoogle Scholar
  201. 201.
    Kainberger F, Fruhwald F, Engel A, et al. Die Sonographie der Achillessehne und ihres Gleitlagers. Fortschr Rontgenstr 1988; 148: 394–7CrossRefGoogle Scholar
  202. 202.
    Kalebo P, Goksor LA, Sward L. et al. Soft-tissue radiography, computed tomography, and ultrasonography of partial Achilles tendon ruptures. Acta Radiol 1990; 31: 565–70PubMedGoogle Scholar
  203. 203.
    Crim JR, Cracchiolo A, Bassett LW, et al. Magnetic resonance imaging of the hindfoot. Foot Ankle 1989; 10: 1–7PubMedGoogle Scholar
  204. 204.
    Marcus DS, Peicher MA, Kellerhouse LE. Achilles tendon injuries: the role of MR imaging. J Comput Assist Tomogr 1986; 13: 480–6CrossRefGoogle Scholar
  205. 205.
    Mink JH, Deutsch AL, Kerr R. Tendon injuries of the lower extremity: magnetic resonance assessment. Tech Orthop 1992; 7: 23–38CrossRefGoogle Scholar
  206. 206.
    Shields C, Kerlan RK, Jobe FW, et al. The Cybex II evaluation of surgically repaired Achilles tendon ruptures. Am J Sports Med 1978; 6: 369–72PubMedCrossRefGoogle Scholar
  207. 207.
    Sjoström M, Fugl-Meyer AR, Wahlby L. Achilles tendon injury. Plantar flexion strength and structure of the soleus muscle after surgical repair. Acta Chir Scand 1978; 144: 219–26PubMedGoogle Scholar
  208. 208.
    McKenzie DC, Taunton JE, Clement DB, et al. Calcaneal epiphysitis in adolescent athletes. Can J Appl Sport Sci 1981; 6: 123–5PubMedGoogle Scholar
  209. 209.
    Williams JGP. Sports injuries. Folia Traumatol 1963: 7–16Google Scholar
  210. 210.
    Bassiouni M. Incidence of calcaneal slurs in osteoarthrosis and rheumatoid arthritis, and in control patients. Ann Rheum Dis 1965; 24: 490–3PubMedCrossRefGoogle Scholar
  211. 211.
    Kettelkamp DB, Alexander HH. Spontaneous rupture of the posterior tibial tendon. J Bone Joint Surg 1969; 51-A: 759–64Google Scholar
  212. 212.
    Lotke M. Ossification of the achilles tendon. Report of seven cases. J Bone Joint Surg 1970; 52-A: 157–60Google Scholar
  213. 213.
    Furey JG. Plantar fascitis. The painful heel syndrome. J Bone Joint Surg 1975; 57-A: 672–3Google Scholar
  214. 214.
    Uhthoff HK, Sarkar K, Maynard JA. Calcifying tendinitis. A new concept of its pathogenesis. Clin Orthop 1976; 118: 164–8PubMedGoogle Scholar
  215. 215.
    Mabuchi H, Ito S, Haba T, et al. Discrimination of familiar hypercholesterolemia and secondary hypercholesterolemia by Achilles tendon thickness. Atherosclerosis 1977; 28: 61–8PubMedCrossRefGoogle Scholar
  216. 216.
    Resnick D, Feingold ML, Curd J, et al. Calcaneal abnormalities in articular disorders. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and Reiter syndrome. Radiology 1977; 125:355–66PubMedGoogle Scholar
  217. 217.
    Hornstein M. Ossification of the Achilles tendon following an avulsion fracture. J Foot Surg 1978; 17: 124–7PubMedGoogle Scholar
  218. 218.
    Rask MR. Achilles tendon rupture owing to rheumatoid disease. Case report with a nine-year follow-up. JAMA 1978; 239: 435–6PubMedCrossRefGoogle Scholar
  219. 219.
    Bansal S, Magnussen CR, Napociano RJ. Haemophilus in fluenzae tenosynovitis. Ann Rheum Dis 1979; 38: 561–2PubMedCrossRefGoogle Scholar
  220. 220.
    Haacke H, Parwaresch MR. Spontaneous rupture of the Achilles tendon — a sign of hyperlipoproteinaemia (HLP) Type II. Klin Wochenschr 1979; 57: 397–400PubMedCrossRefGoogle Scholar
  221. 221.
    Gerster JC. Plantar fascitis and Achilles tendinitis among 150 cases of seronegative spondylarthritis Rheumatol Rehabil 1980; 19:218–22PubMedCrossRefGoogle Scholar
  222. 222.
    Gerster JC, Lagier R, Boivin G. Achilles tendinitis associated with chondrocalcinosis. J Rheumatol 1980; 7: 82–8PubMedGoogle Scholar
  223. 223.
    Awerbruch MS, Brooks PM. Calcific tendinitis at multiple sites. J Med Aust 1981; 21: 189–90Google Scholar
  224. 224.
    Folan JC. Peroneus longus tenosynovitis. Br J Sports Med 1981; 15: 277–9PubMedCrossRefGoogle Scholar
  225. 225.
    Fink RJ, Com RC. Fracture of an ossified Achilles tendon. Clin Orthop 1982; 169: 148–50PubMedGoogle Scholar
  226. 226.
    Mubarak SJ, Gould RN, Lee YF, et al. The medial tibial stress syndrome. A cause of shin splints. Am J Sports Med 1982; 10: 201–5PubMedCrossRefGoogle Scholar
  227. 227.
    Henricson AS, Westlin NE. Chronic calcaneal pain in athletes: entrapment of the calcaneal nerve? Am J Sports Med 1984; 12: 152–4PubMedCrossRefGoogle Scholar
  228. 228.
    Goldberg I, Avidor I. Isolated tuberculous tenosynovitis of the achilles tendon. A case report. Clin Orthop 1985; 194: 185–9PubMedGoogle Scholar
  229. 229.
    Koss PG. Disseminated gonococcal infection. The tenosynovitis-dermatitis and suppurative arthritis syndromes. Cleve Clin Q 1985; 52: 161–73PubMedGoogle Scholar
  230. 230.
    Michael RH, Holder LE. The soleus syndrome. A cause of medial tibial stress (shin splints). Am J Sports Med 1985; 13: 87–94PubMedCrossRefGoogle Scholar
  231. 231.
    Remberger K, Faust H, Keyl W. Tendinitis calcarea. Klinik, Morphologie, Pathogenese und Differentialdiagnose. Pathologie 1985; 6: 196–203Google Scholar
  232. 232.
    Machtey I. Tendinitis and abnormal glucose tolerance. Scand J Rheumatol 1986; 15: 224PubMedCrossRefGoogle Scholar
  233. 233.
    Schilling W, Heine J. Xanthome der Achillessehne. Langzeitergebnisse nach totaler and partieller Resektion. Z Orthop 1986; 124: 225–7PubMedCrossRefGoogle Scholar
  234. 234.
    Heim M, Blankstein A, Amit Y, et al. Case study: persistent ankle pain — the os trigonum duly considered. J Orthop Sports Phys Ther 1987; 8:402–4Google Scholar
  235. 235.
    Havel PE, Ebraheim NA, Clark SE, et al. Tibial nerve branching in the tarsal tunnel. Foot Ankle 1988; 9: 117–9PubMedGoogle Scholar
  236. 236.
    Suso S, Peidro L, Ramon R. Fracture of an ossification of the tendo calcaneus. Acta Orthop Belg 1988; 54: 391–3PubMedGoogle Scholar
  237. 237.
    Leppilahti J, Orava S, Karpakka J, et al. Anomalous soleus muscle as a cause of exertion pain in athletes. Clin Sports Med 1989; 1: 205–10Google Scholar
  238. 238.
    Murison MSC, Bardley I, Slapak M. Tendinitis — a common complication after renal transplantion. Transplantation 1989; 48: 587–9PubMedGoogle Scholar
  239. 239.
    Cantos-Melian B, Arriaza-Loureda R, Aisa-Varela P. Tibialis posterior nerve schwannoma mimicking Achilles tendinitis: ultrasonographic diagnosis. J Clin Ultrasound 1990; 18: 671–3PubMedGoogle Scholar
  240. 240.
    Järvinen M, Kvist H, Józsa L. The intratendineal ossification with fracture in the Achilles tendon of the top-level athlete. Clin Sports Med 1990; 2: 47–51Google Scholar
  241. 241.
    Resnick D. The osteochondroses. In: Resnick D, Niwayaman G, editors. Diagnosis of bone and joint disorders, part II. London: Saunders, 1981; 2875–912Google Scholar
  242. 242.
    Sebes J. The significance of calcaneal spurs in rheumatic diseases. Arthritis Rheum 1989; 32: 338–40PubMedCrossRefGoogle Scholar
  243. 243.
    Stanish WD, Curvin S, Rubinovich M. Tendinitis: the analysis and treatment for running. Clin Sports Med 1985; 4: 593–609PubMedGoogle Scholar
  244. 244.
    Hunter S, Poole RM. The chronically inflamed tendon. Clin Sports Med 1987; 6: 371–88PubMedGoogle Scholar
  245. 245.
    Sundqvist H, Forsskahl B, Kvist M. A promising novel therapy for Achilles peritendinitis: doubleblind comparison of glycosaminoglycan polysulphate and high-dose indomethacin. Int J Sports Med 1987; 8: 298–303PubMedCrossRefGoogle Scholar
  246. 246.
    McKeag DG. Overuse syndromes of the lower extremity. Physician Sportmed 1989; 17: 108–23Google Scholar
  247. 247.
    Nichols AW. Achilles tendinitis in running athletes. J Am Board Fam Pract 1989; 2: 196–203PubMedGoogle Scholar
  248. 248.
    Welsh RP, Clodman J. Clinical survey of Achilles tendinitis in athletes. Can Med Assoc J 1980; 122: 193–5PubMedGoogle Scholar
  249. 249.
    Fernandez-Palazzi F, Rivas S, Mujica P. Achilles tendinitis in ballet dancers. Clin Orthop 1990; 257: 257–61PubMedGoogle Scholar
  250. 250.
    Renström P. Diagnosis and management of overuse injuries. In: Dirix A, Knuttgen HG, Tittel K, editors. The Olympic book of sports medicine (ISBN 0-632-01963-8). Vol 1. Oxford: Blackwell Scientific Publications, 1988; 446–68Google Scholar
  251. 251.
    D’Ambrosia PI, Drez D, editors. Prevention and treatment of running injuries (ISBN 0-913590-86-X). Thorofare: Charles B Slack, Inc., 1982Google Scholar
  252. 252.
    Lutter LD. Injuries in runners and joggers. Minn Med 1980; 63: 45–51PubMedGoogle Scholar
  253. 253.
    Lohrer H. Design and effect of sports shoe insoles for the runner. Sportverletz Sportschäden 1989; 3: 106–11PubMedCrossRefGoogle Scholar
  254. 254.
    Bates BT, Osternig LR, Mason B, et al. Foot orthotic devices modify selected aspects of lower extremity mechanics. Am J Sports Med 1979; 7: 338–42PubMedCrossRefGoogle Scholar
  255. 255.
    Newell SG, Bramwell ST. Overuse injures to the knee in runners. Physician Sportsmed 1984; 12: 81–92Google Scholar
  256. 256.
    Clarke TE, Frederik EC, Hlavac HT. Effects of a short orthotic device on rearfoot movement in running. Podiatr Sports Med 1983a; 1:20–3Google Scholar
  257. 257.
    Milgrom C, Giladi M. Kashtan H, et al. A prospective study of the effect of a shock-absorbing orthotic device on the incidence of stress fractures in military recruits. Foot Ankle 6: 1985; 101–4PubMedGoogle Scholar
  258. 258.
    Schwellnus MP, Jordan G. Reduction of overuse injuries by the wearing of shock absorbing inner soles. Abstracts, XXIV FIMS World Congress of Sports Medicine, Amsterdam, 1990, 109Google Scholar
  259. 259.
    Faunø P, Anreassen I, Kaalund S. The effect of shock absorbing heel pads used by referees during a soccer tournament. Abstracts, XXIV FIMS World Congress of Sports Medicine, Amsterdam, 1990; 142Google Scholar
  260. 260.
    MacLellan GE, Vyvyan B. Management of pain beneath the heel and achilles tendonitis with visco-elastic heel inserts. Br J Sports Med 1981; 15: 117–21PubMedCrossRefGoogle Scholar
  261. 261.
    Lowdon A, Bader DL, Mowat AG. The effect of heel pads on the treatment of Achilles tendinitis: a double blind trial. Am J Sports Med 1984; 12:431–5PubMedCrossRefGoogle Scholar
  262. 262.
    Nigg BM, Herzog W, Read LJ. Effect of viscoelastic shoe insoles on vertical impact forces in heel-toe running. Am J Sports Med 1988; 16: 70–6PubMedCrossRefGoogle Scholar
  263. 263.
    Clarke TE, Frederik EC, Hamill CL. The effects of shoe design parameters on rearfoot control in running. Med Sci Sports Exerc 1983; 15:376–81PubMedGoogle Scholar
  264. 264.
    Lee KH, Matteliano A, Medige J, et al. Electromyographic changes of leg muscles with heel lift: therapeutic implications. Arch Phys Med Rehabil 1987; 68: 298–301PubMedGoogle Scholar
  265. 265.
    Komi P, Hyvarinen T, Kvist M. Biomechanical considerations in the study of impact loads and foot stability during running. In: Kvist M, editor. Paavo Nurmi Congress Book (ISBN 952- 90-1266-7). Advanced European Course on Sports Medicine, 50th Anniversary of the Finnish Society of Sports Medicine. Turku: Grafia Oy, 1989; 219–23Google Scholar
  266. 266.
    Matlalino AJ, Deese Jr JM, Campbell Jr ED. Office evaluation and treatment of lower extremity injuries in the runner. Clin Sports Med 1989; 8: 461–75Google Scholar
  267. 267.
    Schwarz G, Kyrein HJ. Klinische Erfahrungen bei der Behandlung von Sportverletzungen und Sportschäden mit einem Sportgel. Dtsch Z Sportmed 1981; 32: 296–300Google Scholar
  268. 268.
    Chang IY, Chung YK. Park WC. Clinical study of the percutaneous treatment with Mobilat in orthopaedics. New Med J 1982; 25:617–22Google Scholar
  269. 269.
    Kageyama T. A double blind placebo controlled multicenter study of piroxicam 0.5% gel in osteoarthritis of the knee. Eur J Rheumatol Inflam 1987; 8: 114–5Google Scholar
  270. 270.
    Dickson DJ. A double-blind evaluation of topical piroxicam gel with oral ibupfofen in osteoarthritis of knee. Current Ther Res 1991; 49: 199–207Google Scholar
  271. 271.
    Russell AL. Piroxicam 0.5% topical gel compared to placebo in the treatment of acute soft tissue injuries: a double-blind study comparing efficacy and safety. Clin Invest Med 1991; 14: 35–43PubMedGoogle Scholar
  272. 272.
    Lanzetta A, Meani E, Tinti G. Injuries to the Achilles tendon in athletes: their causes and the indications for their treatment. Ital J Sports Traumatol 1981; 3: 113–21Google Scholar
  273. 273.
    Goldie I. Local steroid therapy in painful orthopaedic conditions. Scot Med J 1972; 17: 176–86PubMedGoogle Scholar
  274. 274.
    Day BH, Govindasamy N, Patnaik R. Corticosteroid injections in the treatment of tennis elbow. Practioner 1978; 220:459–62Google Scholar
  275. 275.
    Withrington RH, Girgis FL, Seifert MH. A placebo-controlled trial of steroid injections in the treatment of supraspinatus tendonitis. Scand J Rheumatol 1985; 14: 76–8PubMedCrossRefGoogle Scholar
  276. 276.
    DaCruz DJ, Geeson M, Allen MJ, et al. Achilles paratendonitis: an evaluation of steroid injection. Br J Sports Med 1988; 22: 64–5PubMedCrossRefGoogle Scholar
  277. 277.
    Rhoades CE, Gelberman RH, Manjarris JF. Stenosing tenosynovitis of the fingers and thumb. Results of a prospective trial of steroid injection and splinting. Clin Orthop 1984; 190: 236–8PubMedGoogle Scholar
  278. 278.
    Faunø P, Andersen HJ, Simonsen O. A long-term follow-up of the effect of repeated corticosteroid injections for stenosing tenovaginitis. J Hand Surg 1989; 14-B: 242–3Google Scholar
  279. 279.
    Carstam N. The effect of cortisone on the formation of tendon adhesions and tendon healing. An experimental investigation in the rabbit. Acta Chir Scand 1953; Suppl. 182: 1–111Google Scholar
  280. 280.
    Dockery GL, Nilson RI. Intralesional injections. Clin Podiatry J Med Surg 1986; 3:473–85Google Scholar
  281. 281.
    Gray RG, Gottlieb NL. Intra-articular corticosteroids. An updated assessment. Clin Orthop 1983; 177: 235–63PubMedGoogle Scholar
  282. 282.
    Mackie JW, Goldin B, Foss ML, et al. Mechanical properties of rabbit tendons after repeated anti-inflammatory steroid injec-tions. Med Sci Sports Exerc 1974; 6: 198–202Google Scholar
  283. 283.
    Phelps D, Sonstegard DA, Matthews LS. Corticosteroid injection effects on the biomechanical properties of rabbit patellar tendons. Clin Orthop 1974; 100: 345–8PubMedGoogle Scholar
  284. 284.
    Matthews LS, Sonstegard DA, Phelps DB. A biomechanical study of rabbit patellar tendon: effects of steroid injection. J Sports Med 1975; 2: 349–57Google Scholar
  285. 285.
    McWhorter JW, Francis RS, Heckman RA. Influence of local steroid injections on traumatized tendon properties. A biomechanical and histological study. Am J Sports Med 1991; 19: 435–9PubMedCrossRefGoogle Scholar
  286. 286.
    Kerlan RK, Glousman RE. Injections and techniques in athletic medicine. Clin Sports Med 1989; 8: 541–60PubMedGoogle Scholar
  287. 287.
    Leadbetter WB, Buckwalter JB, Gordon SL, editors. Sports-induced inflammation (ISBN 0-89203-037-2). Park Ridge: American Academy of Orthopaedic Surgeons, 1990Google Scholar
  288. 288.
    Berlin DB, Coleman W, Nickamin A. Surgical approaches to Haglund’s disease. J Foot Surg 1982; 21: 42–4PubMedGoogle Scholar
  289. 289.
    Kvist H. Heparin vid achillessenskada hos idrottsman. Nord Med 1958; 60: 1289–90PubMedGoogle Scholar
  290. 290.
    Larsen Al, Egfjord M. Jelssdorff HM. Low-dose heparin in the treatment of calcaneal peritendinitis. Scand J Rheumatol 1987; 16: 47–51PubMedCrossRefGoogle Scholar
  291. 291.
    Thomas DP, Lane DA, Michalski R, et al. A heparin analogue with specific action on antithrombin III. Lancet 1977; 1: 120–2PubMedCrossRefGoogle Scholar
  292. 292.
    Siegmenth W, Radi J. Vergleich von Glykosaminoglykan Polysulfat (Arteparon®) und physiologischer Kochsalzlösung bei Artrosen grossen Gelenke. Ergebnisse einer multizentrischen Doppelblindstudie. Z Rheumatol 1983; 42: 223–8Google Scholar
  293. 293.
    Paul B. Unsere Erfahrung mit der intraartikularen Arteparon® Therapie bei 350 Patienten wegen bestehender Knorpelschäden am Kniegelenk. Med Sport 1977; 18: 11–4Google Scholar
  294. 294.
    Franke K. Die Folgen der sportlichen Fehlbelastungen an der unteren Extremität. Unfallheilk 1979; 82: 133–42Google Scholar
  295. 295.
    Howell DS, Carreno MR, Pelleber J-P, et al. Articular cartilage breakdown in a lapine model of osteoarthritis. Action of glycosaminoglycan polysulphate ester (GAGPS) on proteoglycan degrading enzyme activity, hexuronate and cell count. Clin Orthop 1986; 213:69–76PubMedGoogle Scholar
  296. 296.
    Howell DS, Muniz OE, Carreno MR. Effect of glycosaminoglycan polysulphate ester on proteoglycan-degrading enzyme activity in an animal model of osteoarthritis. Adv Inflamm Res 1986; 11: 197–206Google Scholar
  297. 297.
    Raatikainen T, Väänänen K, Tamelander G. Effect of glycosaminoglycan polysulfate on chondromalacia patellae. A placebo controlled 1-year study. Acta Orthop Scand 1990; 61:443–8PubMedCrossRefGoogle Scholar
  298. 298.
    Kvist M, Järvinen M, Kujala U, et al. Comparison of arteparon and indomethacin in the treatment of apicitis patellae and peritendinitis of ligamentum patellae athletes. In: Bachl N, Prokop L, Suckerz R, editors. Current topics in sports medicine, Proceedings of the World Congress of Sports Medicine, Vienna, 1982. Vienna: Urban & Schwarzenberg, 1984: 825–35Google Scholar
  299. 299.
    Bonta IL, Bray MA, Parnham MJ, editors. The pharmacology of inflammation. Handbook of inflammation. Vol 5. Amsterdam: Elsevier Science Publishers, 1985Google Scholar
  300. 300.
    Clyman B. Role of nonsteroidal anti-inflammatory drugs in sports medicine. Sports Med 1986; 3: 242–6CrossRefGoogle Scholar
  301. 301.
    Carlstedt CA, Madsen K. Wredmark T. The effect of indometh acin on tendon healing. A biomechanical and biochemical study. Arch Orthop Trauma Surg 1986; 105: 332–6PubMedCrossRefGoogle Scholar
  302. 302.
    Dahners LE, Gilbert JA, Lester GE, et al. The effect of a nonsteroidal antiinflammatory drug on the healing of ligaments. Am J Sports Med 1988; 16: 641–6PubMedCrossRefGoogle Scholar
  303. 303.
    Rogoff JB, editor. Manipulation, traction and massage. 2nd ed. (ISBN 0-683-07324-9). Baltimore: Williams & Williams, 1989Google Scholar
  304. 304.
    Cyriax JH. Clinical applications of massage. In: Rogoff IB, editor. Manipulation, traction and massage (ISBN 0-683-07324- 9). RLM Rehabilitation Medicine Library. Baltimore: Williams & Williams, 1980: 152–69Google Scholar
  305. 305.
    Schmidt H, Frauendorf V, Asmussen U, et al. Der Muskeltest nach Janda für die sportmedizinische Praxis. Med Sport 1983; 23:271–9Google Scholar
  306. 306.
    Shellock FG, Prentice WE. Warming-up and stretching for improved physical performance and prevention of sports-related injuries. Sports Med 1985; 2: 267–78PubMedCrossRefGoogle Scholar
  307. 307.
    Beaulieu JE. Developing a stretching program. Physician Sportsmed 1981; 9: 59–69Google Scholar
  308. 308.
    Wallin D, Ekblom B, Grahn R, et al. Improvement of muscle flexibility. A comparison between two techniques. Am J Sports Med 1985; 13:263–8PubMedCrossRefGoogle Scholar
  309. 309.
    Andrews JR. Overuse syndromes of the lower extremity. Clin Sports Med 1983; 2: 137–48PubMedGoogle Scholar
  310. 310.
    Baker B. Current concepts in the diagnosis and treatment of gastrocnemius-soleus tears. Am J Sports Med 1984; 16:323–7Google Scholar
  311. 311.
    Appel H-J. Skeletal muscle atrophy during immobilization. Int J Sports Med 1986; 7: 1–5CrossRefGoogle Scholar
  312. 312.
    Nicholas JA, Marino M. The relationship of injuries of the leg, foot and ankle to proximal thigh strength in athletes. Foot Ankle 1987; 7:218–28PubMedGoogle Scholar
  313. 313.
    Kellett J. Acute soft tissue injuries — a review of the literature. Med Sci Sports Exerc 1986; 18: 489–500PubMedGoogle Scholar
  314. 314.
    Stevenson JH, Pang CY, Lindsay WK, et al. Functional, mechanical and biochemical assessment of ultrasound therapy on tendon healing in the chicken toe. Plast Reconstr Surg 1986; 77: 965–72PubMedCrossRefGoogle Scholar
  315. 315.
    Owoeye I, Spielhok NI, Nelson AJ. Low-intensity pulsed galvanic current and the healing of tenotomized rat Achilles tendons: preliminary report using load-to-breaking measurements. Arch Phys Med Rehabil 1987; 68: 415–8PubMedGoogle Scholar
  316. 316.
    Jackson BA, Schwane JA, Starcher BC. Effect of ultrasound therapy on the repair of Achiles tendon injuries in rats. Med Sci Sports Exerc 1991; 23: 171–76PubMedGoogle Scholar
  317. 317.
    Delacerda FG. Iontophoresis for treatment of shin splints. J Orthop Phys Ther 1982; 3: 183–85Google Scholar
  318. 318.
    Harris PR. Iontophoresis: clinical research in musculoskeletal/inflammatory conditions. J Orthop Sports Phys Ther 1982; 4: 109–12PubMedGoogle Scholar
  319. 319.
    Siebert W, Seichert N, Sieben B, et al. What is the efficacy of ‘soft’ and ‘mid’ lasers in therapy of tendinopathies? A doubleblind study. Arch Orthop Trauma Surg 1987; 106: 358–63PubMedCrossRefGoogle Scholar
  320. 320.
    Schneider H. Die Abnutzungserkrankungen der Sehnen und ihre Therapie. Stuttgart: Thieme, 1959Google Scholar
  321. 321.
    Allenmark C. Partial Achilles tendon tears. Clin Sports Med 1992; 11: 759–69PubMedGoogle Scholar
  322. 322.
    Enwemeka C, Spielhoz N, Nelson A. The effect of early functional ambulation activities on experimentally tenotomized Achilles tendons in rats. Am J Phys Med Rehabil 1988; 67: 264–9PubMedGoogle Scholar
  323. 323.
    Mabit C, Bellaubre JM, Chanssoux JL, et al. Study of the experimental biomechanics of tendon repair with immediate active mobilization. Surg Radiol Anat 1986; 8: 29–35PubMedCrossRefGoogle Scholar
  324. 324.
    Kellam JF, Hunter GA, McElwain JP. Review of the operative treatment of achilles tendon rupture. Clin Orthop 1985; 201: 80–3PubMedGoogle Scholar
  325. 325.
    Beskin JL, Sanders RA, Hunter SC, et al. Surgical repair of Achilles tendon ruptures. Am J Sports Med 1987; 15: 1–8PubMedCrossRefGoogle Scholar
  326. 326.
    Haggmark T, Liedberg H, Eriksson E, et al. Calf muscle atrophy and muscle function after non-operative vs operative treatment of Achilles tendon ruptures. Orthopedics 1986; 9: 160–4PubMedGoogle Scholar
  327. 327.
    Washburn SD, Caiozo VJ, Wills CA, et al. Alterations in the in vivo torque-velocity relationship after Achilles tendon rupture. Further evidence of speed-specific impartment. Clin Orthop 1992; 279: 237–45PubMedGoogle Scholar
  328. 328.
    Cetti R. A new treatment of ruptured Achilles tendons. In: Hermans GPH, Mosterd WL, editors. Sports medicine and health. Proceedings of the XXIV World Congress of Sports Medicine. Amsterdam, 1990. Amsterdam: Excerpta Medica, 1990: 257–64Google Scholar
  329. 329.
    Carter TP, Fowler PJ, Blokker C. Functional postoperative treatment of Achilles tendon repair. Am J Sports Med 1992; 20: 459–62PubMedCrossRefGoogle Scholar
  330. 330.
    Eiselt B. Unsere Erwährungen über die operative Therapie von Achillodynien. Med Sport 1967; 7: 93–4Google Scholar
  331. 331.
    Ehricht H-G, Passow G. Achillodynie- Achillessehnenruptur-Genese, Klinik, Therapie, Prophylaxe und Metaphylaxe. Med Sport 1972; 12: 333–40Google Scholar
  332. 332.
    Gould N, Korson R. Stenosing tenosynovitis of the pseudo-sheath of the tendo Achilles. Foot Ankle 1980; 3: 179–87Google Scholar
  333. 333.
    Subotnick SI. Surgical treatment of Achilles tendon tenosynovitis (paratenonitis) in runners. J Am Podiatry Assoc 1977; 67: 280–2PubMedGoogle Scholar
  334. 334.
    Donatelli R, Owens-Burkhart H. Effects of immobilization on the extensibility of periarticular connective tissue. J Orthop Sports Phys Ther 1981; 3: 67–72Google Scholar
  335. 335.
    Schepsis AA, Leach PE. Surgical treatment of Achilles tendinitis. Am J Sports Med 1987; 15: 308–15PubMedCrossRefGoogle Scholar
  336. 336.
    Nelen G, Martens M, Burssens A. Surgical treatment of chronic Achilles tendinitis. Am J Sports Med 1989; 17: 754–9PubMedCrossRefGoogle Scholar
  337. 337.
    Leadbetter WB, Mooar PA, Lane GJ, et al. The surgical treatment of tendinitis. Clinical rationale and biologic basis. Clin Sports Med 1992; 11:679–712PubMedGoogle Scholar
  338. 338.
    Grafin SR, Tipton CM, Mubarak SJ, et al. Role of fascia in maintenance of muscle tension and pressure. J Appl Physiol 1981; 51:317–20Google Scholar
  339. 339.
    Pai M, Hunt T. Effect of varying oxygen tensions on healing of open wounds. Surg Gynecol Obstet 1972; 135: 756–8PubMedGoogle Scholar
  340. 340.
    Kvist M, Järvinen M. Zur Epidemiologie von Sportverletzungen und Fehlbelastungsfolgen: Patienten-Analyse einer sportmedizinischen Poliklinik. Med Sport 1980; 20: 375–8Google Scholar
  341. 341.
    Jones DC, James SL. Partial calcaneal osteotomy for retrocalcaneal bursitis. Am J Sports Med 1984; 12: 72–3PubMedCrossRefGoogle Scholar
  342. 342.
    Söndenaa K. Achillobursitt. Ett 10-arsmateriale med operativ behandling. Tidsskr Nor Laegeforen 1978; 98: 955–6PubMedGoogle Scholar
  343. 343.
    Smith LS, Tillo TH. Haglund’s deformity in long distance runners. Nine surgical cases. Podiatr Sports Med 1988; 78: 419–23Google Scholar
  344. 344.
    Steffensen JCA, Evensen A. Bursitis retrocalcanea achilli. Acta Orthop 1958; 27: 228–36Google Scholar
  345. 345.
    Miller AE, Vogel TA. Haglund’s deformity and the Keck and Kelly osteotomy: a retrospective analysis. J Foot Surg 1989; 28: 23–9PubMedGoogle Scholar
  346. 346.
    Cetti R. Complication-free Achilles tendon repair. Br J Sports Med 1982; 16: 230–5PubMedCrossRefGoogle Scholar
  347. 347.
    Renström P. Achilles tendon ruptures. In: Kvist M, editor. Paavo Nurmi Congress Book (ISBN 952-90-1266-7). Advanced European Course on Sports Medicine. 50th Anniversary of the Finnish Society of Sports Medicine. Turku: Grafia Oy, 1989: 259–62Google Scholar
  348. 348.
    Fugl-Meyet AR, Nordin G, Sjoström M, et al. Achilles tendon injury. 5. A model for isokinetic strength training using bio-feedback. Scand J Rehabil Med 1979; 11: 37–44Google Scholar
  349. 349.
    Stanish WD. Overuse injuries in athletes: a perspective. Med Sci Sports Exerc 1984; 16: 1–7PubMedCrossRefGoogle Scholar
  350. 350.
    Stanitski CL. Common injuries in preadolescent and adolescent athletes. Recommendations for prevention. Sports Med 1989; 7: 32–41PubMedCrossRefGoogle Scholar
  351. 351.
    Taimela S, Kujala U, Osterman K. Intrinsic risk factors and athletic injuries. Sports Med 1990; 9: 205–215PubMedCrossRefGoogle Scholar
  352. 352.
    Segesser B. Aetiologie und Prophylaxe von Sportshaden. Schweiz Z Sportmed 1976; 25: 99–129Google Scholar
  353. 353.
    Fleck SJ, Falkel JE. Value of resistance training for the reduction of sports injuries. Sports Med 1986; 3: 61–8PubMedCrossRefGoogle Scholar
  354. 354.
    Hess GP, Cappiello WL, Poole RM, et al. Prevention and treatment of overuse tendon injuries. Sports Med 1989; 8: 371–84PubMedCrossRefGoogle Scholar
  355. 355.
    Kilbom A, Hanley LH, Saltin B, et al. Physical training in sedentary middle-aged and older men. I. Medical evaluation. Scand J Clin Lab Invest 1969; 24: 315–22PubMedCrossRefGoogle Scholar
  356. 356.
    Gordon GM. Podiatric sports medicine. Evaluation and prevention of injuries. Clin Podiatry 1984; 1: 401–16PubMedGoogle Scholar
  357. 357.
    Hulkko A. Stress fractures in athletes. A clinical study of 368 cases. Thesis. Acta Universitatis Ouluensis. Series D, Medica 169. Oulu: Oulu University, 1988Google Scholar
  358. 358.
    Safran MR, Seaber AV, Garrett Jr WE. Warm-up and muscular injury prevention. An update. Sports Med 1989; 8: 239–49PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 1994

Authors and Affiliations

  • Martti Kvist
    • 1
  1. 1.Sports Medical Research Unit, Paavo Nurmi CentreUniversity of TurkuTurkuFinland

Personalised recommendations