Achilles tendinopathy is a common condition in both athletes and patients with systemic inflammatory conditions. The current underlying mechanism of Achilles tendinopathy is a much discussed topic, and a consensus is still to be reached. Despite the presenting clinical features of a symptomatic Achilles tendon in these two groups being similar, the underlying disease processes are clearly different.

The aim of this project is to compare the clinical, imaging and histopathological assessment of tendinopathy in the two distinct patient groups (inflammatory and non-inflammatory).

The hypothesis is that there are distinct imaging and histopathological features which distinguish inflammatory vs non-inflammatory tendinopathy.

Patients with symptomatic Achilles tendons will be recruited from 2 groups – those with a systemic inflammatory condition such as a spondyloarthropathy, and athletes presenting to the sports clinic. Patients will be examined clinically, assessing the site of pain, any swelling and the presence of other symptomatic ankle tendons . The VISA-A score will be used to assess clinical severity. 2D and 3D ultrasound will be employed to look at the tendon architecture and vascularity.

Histological examination and immunohistochemistry of Achilles tendon biopsies will examine the collagen and proteoglycan content and structure, cellular infiltrate, cytokine profile and the presence of markers of collagen and proteoglycan production and breakdown.

It will be interesting to assess the correlation of US doppler signal and histopathological characteristics as well as to prospectively correlate all the above assessments with clinical outcome.