A. Stopping point Achilles tendinitis is a lesion of the Achilles tendon at the stopping point of the Achilles bone, the cause of which is not well understood. Not only can such lesions occur in athletes, but also in middle-aged and elderly people who do not play sports well. In athletes, Achilles tendinitis may be caused by inadequate preparation for exercise, sudden changes in exercise volume, and frequent activity on uneven or sloped surfaces. The Achilles tendon is subjected to excessive abnormal and repetitive stresses that result in small tears. In contrast, non-athlete stopping Achilles tendonitis, which is generally seen in middle-aged and older women who are overweight, may occur more as a result of degeneration rather than overactivity. In addition, abnormalities in the force lines of the foot are also causes of Achilles tendon injury and degeneration. For example, excessive rotation of the foot is an imbalance in the stress on the Achilles tendon, which increases the moment of the Achilles tendon and increases the load on the Achilles tendon. The high arch of the foot weakens the foot’s role in absorbing ground stress during walking and increases the stress on the Achilles tendon. Posterior heel pain can also be caused by a number of systemic diseases, such as ankylosing spondylitis and gout. In patients with stopping point Achilles tendinitis, fibrous mucous-like degeneration occurs at the stopping point of the Achilles tendon, and finally fibrosis and calcification, thickening of the Achilles tendon with nodule formation. Wu Gang, Department of Minimally Invasive Foot and Ankle Surgery, National Rehabilitation Assistive Devices Research Center Affiliated Rehabilitation Hospital Stopping point Achilles tendonitis is often combined with changes in other surrounding structures. For example, the posterior superior Achilles nodule may be hypertrophic and inflammatory to the Achilles tendon capsule causing pain. After wearing narrow or stiff shoes, the skin of the protruding area and the upper of the shoe rub together to produce inflammation of the subcutaneous capsule, which can also cause pain. Since Patrick Haglund first described this lesion in 1928, the posterior superior heel node can be hyperplastic and hypertrophic and is also known as Haglund’s deformity. II. Clinical presentation. Stopping point Achilles tendonitis in athletes often presents as pain in the heel during exercise. It usually does not affect daily activities. Non-athlete’s achilles tendonitis may gradually appear as pain in the posterior part of the heel. It may start as intermittent pain and then become constant pain. The Achilles tendon stop is normal or enlarged in appearance, with localized painful pressure. It makes it difficult or painful for the patient to lift the heel with one foot. In a small number of patients, rupture of the Achilles tendon may occur with activity and a positive Thompson test. Achilles tendon capsulitis usually develops in middle-aged and elderly people who do not exercise much. The typical course of the disease is sudden onset of pain and localized swelling in the posterior heel. Local skin temperature may be elevated, and there may be pressure pain on both the medial and lateral aspects of the Achilles tendon, which may be aggravated by passive dorsiflexion of the ankle. Haglund deformity usually occurs in young people. It presents as a posterior lateral protrusion of the heel tuberosity. If not combined with bursitis there may be no clinical symptoms. The skin of the bone protrusion and the abrasion of the shoe upper cause localized skin redness and pain. However, in many patients, stopping point Achilles tendinitis, Achilles bursitis and Haglund deformity coexist. Laboratory tests are performed to check blood uric acid, as well as HLA-B27 and other tests to determine the presence of gouty arthritis and ankylosing spondylitis. X-ray manifestations: the loss of the anterior Achilles tendon capsule shadow is seen on lateral X-ray, the widening of the Achilles tendon by more than 9 mm in the 2 cm above the bursal eminence, and calcification and bone formation are seen at the Achilles tendon attachment. MRI is generally not used as a routine examination. If non-surgical treatment fails and surgical treatment is required, MRI can clearly show the protrusion of Achilles tendon, bursa and Achilles tuberosity in order to facilitate the design of surgical plan. Treatment. 1.Non-surgical treatment. Ninety-five percent of patients can achieve better results with non-surgical treatment. (1) For athletes with stopping Achilles tendonitis, the amount of exercise should be appropriately reduced and running and jumping on ramps or hard surfaces should be avoided. Severe symptoms may require rest or braking for 4 to 6 weeks. (2) Cold compresses may be used after exercise. (3) Non-steroidal anti-inflammatory and pain-relieving drugs (NSAIDs). Hormone injections may be used for Achilles tendon capsule inflammation, but do not inject into the Achilles tendon. For gout, colchicine and allopurinol are needed, and for rheumatoid arthritis, appropriate medical management is needed. (4) Wear soft shoes to reduce the compression of the Achilles tendon stop, and also use Achilles tendon socks with silicone pads for protection. Soft Achilles tendon sheaths can reduce the stress on the Achilles tendon and reduce pain …… Heel elevation can also reduce the stress on the Achilles tendon. Orthopedic shoes or foot pads can correct the poor force line of the foot to achieve the purpose of reducing the stress on the Achilles tendon. (5) Physical therapy, gentle Achilles tendon pulling exercises. (6) For non-athlete stopping Achilles tendonitis, the above non-surgical treatment methods can also be tried first. However, the general bad activity of middle-aged and elderly patients, the effect of non-surgical treatment is poor, may need to be surgical treatment. 2.Surgical treatment. Surgical treatment can remove the degenerative and inflammatory tissues of Achilles tendon at the stopping point, bursa and the hyperplastic posterior superior heel nodes. If the extent of Achilles tendon lesion is large, after removing the lesion tissue, the Achilles tendon attachment is lost, the Achilles tendon stop point needs to be reconstructed, and the Achilles tendon is directly sutured to the Achilles tuberosity. If the stop cannot be reconstructed, the Achilles tendon needs to be reconstructed with a tendon transposition, such as using the flexor digitorum longus tendon to reconstruct the Achilles tendon. Some patients can undergo minimally invasive arthroscopic lesion removal surgery.