Achilles Pain, Stiffness, and Muscle Power Deficits: Midportion Achilles Tendionpathy CPG

Question 1

Achilles CPG: Diagnosis/Classification

Answer 1

C level:

• arc sign
• royal london hospital test
• pain located 2-6cm proximal to achilles tendon insertion that began gradually
• pain with palpation of midportion of tendon

Question 2

Achilles CPG: Exam: outcome measures: activity limitations/self-reported measures

Answer 2

A level:

• VISA-A for pain and stiffness
• FAAM for activity and participation
• LEFS for activity and participation

Question 3

Achilles CPG: Exam: activity limitations/physical performance measures

Answer 3

B level: hop and heel raise endurance tests

Question 4

Achilles CPG: Exam: physical impairment measures

Answer 4

B level: ankle DF ROM, subtalar jt ROM, PF strength and endurance, static arch height, forefoot alignment, pain with palpation.

Question 5

Achilles CPG: Interventions: Exercise

Answer 5

A level: mechanical loading in form of eccentric exercise, heavy-load slow speed (concentric and eccentric) program
F level: exercise at least 2x/wk within pain tolerance

Question 6

Achilles CPG: Interventions: Stretching

Answer 6

C level: stretch and PFs with knee flexed and extended to dec pain and improve outcome satisfaction if they have limited ankle DF

Question 7

Achilles CPG: Interventions: NMR

Answer 7

F level: use NMR to target LE impairments

Question 8

Achilles CPG: Interventions: Manual therapy

Answer 8

F level: consider jt mobs to improve mobility and function, and STM to increase ROM.

Question 9

Achilles CPG: Interventions: Pt ed: activity modifications

Answer 9

B level: nonacute, complete rest is NOT indicated, should continue with recreational activity within pain tolerance while participating in rehab.

Question 10

Achilles CPG: Interventions: Pt counseling

Answer 10

E level:

1. theories supporting use of PT and role of mechanical loading
2. Modifiable risk factors including BMI and shoewear
3. Typical time course for recovery

Question 11

Achilles CPG: Interventions: Heel lifts

Answer 11

D level: contradictory evidence, no recommendation

Question 12

Achilles CPG: Interventions: Night splints

Answer 12

C level: should NOT use night splints

Question 13

Achilles CPG: Interventions: Orthoses

Answer 13

D level: contradictory evidencem no recommendation

Question 14

Achilles CPG: Interventions: Taping

Answer 14

F level: should NOT use therapeutic elastic tape to reduce pain or improve functional performance
F level: may use rigid taping to dec strain on achilles tendon or to alter foot posture

Question 15

Achilles CPG: Interventions: Low level laser therapy

Answer 15

D level: contradictory evidence, no recommendations

Question 16

Achilles CPG: Interventions: Iontophoresis

Answer 16

B level: should use iontophoresis with dexamethasone to decrease pain and improve function

Question 17

Achilles CPG: Interventions: Dry needling

Answer 17

F level: may use dry needling combined with injection under US guidance, and eccentric exercise for pts with symptoms >3mo and increased tendon thickness