Achilles

Question 1

RF for achilles tendinopathy

Answer 1

male
sudden increase in intensity of training, changes in terrain, footwear
DF is less than <11.5
abnormalities in subtalar ROM
pronation
degenerative changes
presence of systemic diseases
corticosteroid use

Question 2

RF for achilles rupture

Answer 2

male
increasing age
decreased tendon fibril size
corticosteroid use
renal failure
diabetes
high BMI

Question 3

MOI of achilles rupture

Answer 3

sudden force into PF
violent DF in a PF foot

usually occurs 4-6 cm above calcaneal insertion

Question 4

S/S of Achilles rupture

Answer 4

weakness
difficulty walking or bearing weight
pain in heel
feeling of being shot or hearing a shot, being kicked in back of leg

Question 5

Thompson’s test

Answer 5

pt prone, knee flexed to 90°
squeeze calf and note movement of foot

test is positive if there is no plantarflexion

Question 6

Physical exam of achilles rupture

Answer 6

visible gap/defect
increased dorsiflexion in prone
weakness with PF

Question 7

Noninsertional tendinopathy

Answer 7

located approx 6 cm proximal to insertion on calcaneus

RF: limited DF ROM, abnormal subtalar ROM, decreased PF strength, foot pronation, obesity/HTN/diabetes

Question 8

Insertional tendinopathy

Answer 8

at insertion on calcaneus and 2 cm above
less frequent than non-insertional
more common in overweight and less active populations
bursitis present, bone involvement

Question 9

Interventions for Non-insertional tendinopathy

Answer 9

decrease load/stress on tendon in acute phase
increase dorsiflexion ROM
orthotics
muscle performance training

do as tolerated eccentric or a heavy load, slow speed

Question 10

Interventions for insertional tendinopathy

Answer 10

may not tolerate eccentrics or stretching that include DF ROM

Question 11

What loading is reasonable during rehab?

Answer 11

need 2-3 Nm/kg to get training dosage that equals function