Achilles Pain/ Stiffness/ Muscle Power

Question 1

What outcome measures to use for Achilles Tendonopathy

Answer 1

1. VISA- A. (Victorian Institute of Sport Assessment- Achilles)- for pain/ stiffness
2. FAAM (Foot and Ankle Measure)- activity and participation
3. LEFS- activity and participation

Question 2

What performance measures can you use to measure functional status for achilles injury

Answer 2

Hop and heel raise endurance tests

Question 3

What physical impairments should you measure for achilles pain (objective)

Answer 3

1. Ankle Dorsiflexion
2. Subtalar ROM
3. Plantar flexion Strength and Endurance
4. Static Arch Height
5. Forefoot alignment
6. Pain with palpation
7. Positive Arc sign
8. Positive Royal London Hospital Test

Question 4

What exercises should you use to decrease achilles pain

Answer 4

eccentrics

heavy load/ slow speed- concentrics and eccentrics

Question 5

What should you advise for achilles tendonopathy regaurding rest

Answer 5

Complete rest is not indicated- continue within recreational activity

Question 6

What about heel lifts?

Answer 6

no recommendation can be made

Question 7

What about night splints?

Answer 7

No use of night splints for achilles tendonopathy

Question 8

What about orthotics?

Answer 8

no recommendation for achilles tendonopathy

Question 9

What about Iontophoresis?

Answer 9

Can use with Dexamethasone to decrease pain and improve function

Question 10

What are some of the risk factors for developing?

Answer 10

1. Obesity
2. tendon abnormalities seen on ultrasound
3. Improvements seen with shock absorbing insoles
4. Family history (level 3 evidence)

Question 11

What are some subjective and palpation diagnostics for achilles tendonopathy?

Answer 11

2-6 cm pain prox to insertion
pain with palpation to midportion of achilles
Gradual onset of pain

Question 12

Describe the Arc Test for Achilles tendonopathy

Answer 12

Palpable nodule with active DF/ PF

Question 13

Describe the Royal London Hospital Test

Answer 13

Pain decreases with palpation in dorsiflexion

Question 14

What imaging would you recommend with patients not progressing with Achilles pain, and what might you try to be ruling out?

Answer 14

MRI/ US

partial ruptures, bursitis, paratendonitis, plantaris involvement, fascial tears

Question 15

What are some acute diagnostic indicators for achilles tendonopathy

Answer 15

Redness/ warmth/ swelling 
< 3 mon 
High levels of pain limiting low level activity- like walking 
Loss of motion 
Painful motion

Question 16

What are the non- acute diagnostic indicators for Achilles tendonopathy?

Answer 16

No redness/ warmth/ swelling 
> 3 mon 
Pain after onset/ completing high level activity- like running/ jumping 
Pain with palpation 
decreased and painful motion 
Abnormal biomechanical findings

Question 17

If a patient is not improving what are some things you can refer out for?

Answer 17

Extracorporeal shockwave therapy- supported
Corticosteroid Injection- short term with complications
PRP- not supported