Enthesopathy is a condition affecting the entheses. These designate in particular the parts of tendons and ligaments which are inserted at the level of the bones. Enthesopathy can thus take place at many levels of the body (Achilles tendon, hip, shoulder, etc.). It has a mechanical or inflammatory origin, and is mainly manifested by pain. Appropriate care is necessary to relieve pain.

Definition of enthesopathy

Enthesopathies correspond to a set of pathologies affecting the entheses, the portions of different fibrous structures inserting themselves at the level of the bones. For example, the portion of the Achilles tendon inserting at the level of the calcaneus (bone located at the level of the heel) is an enthesis. This medical term can also refer to the insertion of a ligament and joint capsules at the level of a bone. 

Thus, enthesopathy can manifest itself at many levels of the body. One of the most common is Achilles enthesopathy, which affects the Achilles tendon. There are also others such as enthesopathy of the hip, shoulder, elbow or knee.

Types d’enthésopathies

Within enthesopathies, health professionals generally distinguish two main types:

• mechanical entesopathy which is characterized by a local mechanical disorder, an accumulation of biomechanical constraints at the level of entheses (tendons, ligaments, etc.);
• inflammatory enthesopathy, also called more simply enthesitis, which in turn results from an inflammatory disease.

In some cases, inflammatory entesopathy is accompanied by a deposit of calcium in the affected area. We can then speak of calcifying enteropathy.

Causes of enthesopathy

As mentioned previously, there are two main types of enthesopathies which have different origins.

Regarding mechanical entesopathy, it may be due to:

• significant stress on the enthesis, especially on the Achilles tendon with Achilles enthesopathy which may for example be due to excessive tension during intensive practice of a sport or a shortening of the calf muscles caused by sedentary lifestyle and overweight;
• a traumastime.

For inflammatory enteropathy, it can be linked to various inflammatory reactions. It is particularly often observed during spondyloarthritis. These designate a set of inflammatory pathologies affecting the joints.

Diagnosis of enthesopathy

The diagnosis of enthesopathy can be based on:

• a clinical examination supported by a questioning in order to identify the pains characteristic of enthesopathy;
• medical imaging tests, such as ultrasound or magnetic resonance imaging (MRI), to confirm symptoms.

It was found that mechanical enthesopathy could be favored by:

• physical inactivity ;
• overweight ;
• the intensive practice of a sport.

It seems that certain genetic predispositions can increase the risk of inflammatory enthesopathy.

• Localized pain: Whether of mechanical or inflammatory origin, enthesopathy essentially results in pain at the level of the affected enthesis (tendon, ligament, etc.). The pain manifests itself during the tension of the enthesis, that is to say during movements. It can also be seen by tenderness to touch.
• Possible swelling: In case of superficial inflammatory enthesopathy, local swelling may be observed. A slight swelling of the affected area may thus accompany the pain.

The management of enthesopathy may be different depending on the case. It depends in particular on the cause identified during the diagnosis. 

Support can be based on:

• physiotherapy with the implementation of stretching exercises, especially in the calf muscles in case of Achilles enthesopathy;
• wearing medical devices such as a splint to be worn at night to stretch the muscles, or heel pads in the case of Achilles enthesopathy to relieve pain and reduce strain on the tendon;
• drug treatments, such as anti-inflammatory drugs, analgesics and muscle relaxants for inflammatory enthesopathy.

To date, prevention advice mainly concerns mechanical enthesopathies. In particular, it is recommended to:

• fight against a sedentary lifestyle by practicing regular physical activity;
• do not neglect the warm-up and cool-down periods during the effort;
• have equipment adapted to their sporting practice, such as shoes with good cushioning;
• maintain a healthy and balanced diet.