Achilles Tendinopathy

Question 1

Prevalence

Most frequently with ______/______

Answer 1

overuse/injury

Question 2

Most common in…

1. _______/_______ activities
2. _________ > competition
3. ___-____ year olds
   10-20% of _______

Answer 2

recreational/competitive
training
30; 50
runners

Question 3

Risk Factors and Etiology
- Limited calf ________
- Calf ________ could lead to under supply/overuse
- Biological _____ and family _____
- Excessive ________

Answer 3

flexibility
weakness
males; hx
pronation

Question 4

Overuse may occcur with _____ ______ control, which includes ______ _______ deficits and ______ deficits

Answer 4

impaired LQ
hip neuromuscular
balance

Question 5

Excessive Pronation is a earlier extended and or excessive combination of ____/_____/_____

Answer 5

DF; ABD; EV

Question 6

Excessive pronation can become excessive if there is ______/_______ present

More commonly:
_______ or _________

Impaired ______ _____- top down influence

Less commonly: ______ or medial ______ hypermobility

Answer 6

hypermobility; instability

tibfib; talocrural

LQ control

subtalar; knee

Question 7

Excessive pronation may become excessive if ______ ________ hypombility is present

Ex:
Limited ______ _______ may lead to midfoot and forefoot excessively EV and ABD

Limited _____ ______ may lead to excessive ankle DF

Answer 7

adjacent joint

talocrural DF

knee EXT

Question 8

Risk Factors and Etilology

Abnormal _______ structure and prior _______

______ age (more plastic)

Also consider… _____ errors, _______ factors, and improper _________

________- overuse

Systemic dz with persistent _______ and poor _______ _______

Answer 8

tendon; injury
older
training; environmental; shoes
obesity
inflammation; blood supply

Question 9

Pathomechanics

Repetitive ______ with _______ from limited ____ and or excessive _______

Collagen fibril ________/_________ and fibroblast death from altered fluid movement leads to _______, ________ nitric acid with persistent ___________

Answer 9

lengthening; compression
DF; EV
thinning; disorganization
overheating; increased; inflammation

Question 10

Pathomechanics

Thickened but _______ tendon from:
increase of ____-______ matrix

fat _________

________ force transfer

Impaired _______ _________

Answer 10

weaker
non-collagen
deposition
ineffective
motor control

Question 11

Symptoms

_______ onset that limits ______ activity

Localized _____ and _______

Particurarly after __________

Lessens with _____ bout of activity and increases with _____ to ______ activity

Answer 11

gradual; WB
pain; stiffness
inactivity
mild; moderate; severe

Question 12

Signs
Observation- Achilles _______
Possibly impaired ____ _____ and or excessive _______

ROM- possible P! and limitation with ______

Resisted/MMT: Possible pain with _____, may be _____
possibly ____/______ weakness

Accessory Motion- possible _______ hypomobility for _______

Palpation- TTP 2-6 cm proximal to ______ (higher seas) area of less _____ ______

More _____ achilles P! indicates plantaris involved

Achilles _______ (high spec)

Answer 12

thickening
LQ control
pronation
DF
PF; weak
hip; knee
talar; DF
insertion; blood supply
medial
crepitus

Question 13

Special Tests

1. _____ ____ (high spec)
2. _____ _____ Test (high spec)
3. ________ Tests
4. _______ _______ _______
5. M. length- shortened ______

Answer 13

Arc Sign
Royal London
Stability
Single Heel Raise
Gastrocs

Question 14

PT Rx
_______ NOT indicated

_______ stress is BEST within appropiate P! levels

______ management

______ wear

Timeline: ____-_____ wks

Prognosis: ______%

POLICED

Answer 14

Rest
Optimal
Weight
Shoe
8; 12
80

Question 15

PT Rx
Modalities
LASER: ___________

Ionto: dexamethasone helpful for ____ function

Shockwave Therapy: support for P! relief with ADLs when added to ____ weeks of exercise

NO indication on ______ changes or return to sport

Answer 15

contradictory

P!

4

structure

Question 16

PT Rx
Bracing: _______ sleeves on involved mm.- anecdotal

Night Splint: NOT _____ and NO ______

Answer 16

Neoprene
beneficial; support

Question 17

PT Rx
Taping, including kinesiotape along tendon to reduce P! is found to be ______ and _______

Arch taping/foot orthotics- ______ evidence
- ______ taping may help predict orthotic benefit
- ______ absorbing orthotic decreases rate of injury

Answer 17

anecdotal ; conflicting

limited

arch; shock

Question 18

PT Rx
Heel Lift
- _____ support
- both _______

Answer 18

mixed
shoes

Question 19

PT Rx
Dry Needling can be helpful for _____ when added to ______

STM- mostly _______

Gentle Stretching: _____ and may be contraindicated due to ______/_______ on tendon

JMs for ______ and _______

Answer 19

pain; exercise

anecdotal

weak; compression; tendon

mobility; function

Question 20

MET Purpose: ________ and ________ (hip and lumbar)

__-___ sets; ___-____ reps; _____ load

Varied _____ actions (BEST evidence) how may seconds?

Answer 20

proliferation; stabilization

2; 3
10; 15
heavy

muscle

3

Question 21

Exercise progressions

1. _______ loading w/o _______ from lengthening
2. _______ loading w/o ________ from lengthening
3. ________ loading with _______ from lengthening
4. ________ loading in ______- (CC Hip ABD/ER/EXT)
5. ________ loading

Answer 21

isometric; compression
isotonic; compression
isotonic; compression
isometric; WBing
Plyometric

Question 22

Best exercises for achilles tendinopathy

Answer 22

Unilateral heel raises; 3x3 secs m. actions

Question 23

With achilles tendionapthy, you want to progress _______ and activity with ≤ _____ symptoms for at least ___/wk and keep up for ____-_____ weeks

Answer 23

resistance; mild
2
6; 12

Question 24

Prognosis
Mostly normalized tendon _____ and ______

Improved ______ proporties as well as cortical function

_____ weeks to recovery

____% fully recovered within ___-_____ months of progressive loading @ 5 year follow up

Eccentric exercises- 82-100% ___-____ tendinopathy in athletes

60%- _______ individuals

≤32%- _______ tendon

_______ P! may remain (20-45%)

Answer 24

structure; thickness

mechanical

12

80

3; 6

mid; portion

sedentary

insertional

mild

Question 25

MD Rx
Injections
______-_______-: insufficient evidence for Cortisone

_______: guided Cortisone effective for P! and function (non-athletic population)

Achilles _______
Remove _______

Answer 25

mid- portion
insertional
debridement
plantaris