Santi Cazorla missed the majority of March and April earlier this year due to Achilles Tendinitis, picked up when returning to training from a 98-day knee injury lay-off.

Achilles Tendonitis is basically a strain on the tendon due to load. However, Santi now has Achilles Tendinosis where the tendon (shown below) has degenerated with small lesions.

This can generally occur from a build-up of repeated, smaller injuries, which ultimately take their toll.

Achilles tendon and other ankle-related tendons – Image courtesy iMuscle 2,

The fact that it occurred following a long layoff is also typical in cases where the patient has been idle and suddenly applies stress to the tendon such as repeated quick running starts and/or running up hills for prolonged periods.

If not addressed, repeated strain on the tendon could result in tearing, which usually requires surgery. This is probably why Arsene Wenger cautiously took Santi off with a knock during Wednesday’s Champions League match with Ludogorets.

Aside from just alleviating the pain from applying pressure on the tendon from just walking or standing, this recent knock can easily be treated through typical rest, icing, compression and elevation (RICE). Any inflammation can also be treated with non-steroidal anti-inflammation drugs (NSAIDs) such as aspirin, ibuprofen and naproxen.

Care needs to be taken as the tendon heals not to cause secondary issues from non-use once returning to training.

For example, the tendons lateral to that area, primarily the Tibialis Posterior and Fibularis Longus – both just behind the ankle, as well as the Soleus underneath may become stiff from non-use. These could become similarly strained with any sudden trauma.

This could have factored in the decision to leave the Spanish international out of the team sheet versus Middlesbrough at the weekend.

Speaking after the game, Arsene Wenger admitted that he was not sure when the midfielder would return to action.