Achilles Tendinopathy Flashcards
Achilles Tendinopathy Special Test = ?
Achilles Tendinopathy
Achilles Rupture, Special Test = ?
Achilles Tendinopathy
Royal London Hospital Special Positive Test = ?
Achilles Tendinopathy
Achilles - Royal London Hospital Special Test =
- (+) test if the painful spot moves with plantarflexion and no pain is felt dorsiflexing.
Heel Raise Special Test:
- Test for = ?
Achilles Tendinopathy
Achilles Tendinopathy - Heel Raise Special Test
Eccentric loading, stretching, and foot orthoses can be beneficial treating = ?
Achilles Tendinopathy
Achilles Tendinopathy:
- Eccentric Loading = Decrease pain and improve function in patients with midportion achilles tendinopathy.
- Stretching = Decrease pain and improve function in patients with limited dorsiflexion ROM w/ achilles tendinopathy.
- Foot Orthoses = Decrease pain and alter ankle & foot kinematics while running in patients with achilles tendinopathy.
Eccentric strengthening protocol for achilles tendinopathy = ?
Achilles Tendinopathy
Eccentric Strengthening Protocol:
- Every other day
- 3 x 12 reps
- Leg straight & bent
- Progress from BW to loaded (weight in backpack)
When should we begin eccentric strengthening when treating the Achilles tendon ?
Achilles Tendinopathy
Achilles Tendon Treatment:
- Begin eccentric strengthening after 2 weeks of decreasing symptoms.
What should be taken into account when considering return to sport = ?
Achilles Tendinopathy
Return to Sport or Activity:
Achilles Tendinosis / Tendonitis
Pain pattern = ?
Achilles Tendinopathy
Pain Pattern:
- Acute pain over the posterior heel, and Achilles Tendon (At the insertion of the tendon or mid tendon).
- Pain is worse after sleeping or periods of inactivity.
- Popping is frequently heard/felt as if the patient were kicked in the back of the leg.
- Long-term pain progression with degenerative tears.
Achilles Tendinosis / Tendonitis
Risk Factors & Observations = ?
- Risk Factors:
- Quick end range dorsiflexion during athletic events
- Abnormal DF ROM, hyper or hypo (11.5 d of DF w/ knee extended = increased risk 3.5x)
- Abnormal subtalar joint ROM (Inversion excessive 32.5 d = risk 2.8x)
- Decreased ankle plantar flexion strength
- Increased foot pronation
- Observation
- Hagland’s deformity
- Enlargement of tendon
- Nodule in tendon
Achilles Tendinosis / Tendonitis
Manual therapy should include = ?
Achilles Tendinopathy
Manual Therapy:
- Bracing:
- Initially boot may be necessary to control inflammation
- Joint Mobilization:
- Edema management technique if present.
- Cross friction massage
- Mob. for Dorsiflexion & subtalar mobility
- Soft tissue to posterior chain
- Low level laser supported with moderate evidence especially in acute cases
- Heel lifts may reduce some stress on the tendon temporarily
Therapeutic Exercise should include = ?
Achilles Tendinopathy
Therapeutic Exercise:
- Motor:
- Alfredson Achilles Tendinopathy (Heavy load eccentric focus)
- Limit ROM eccentrics w/ insertional
- Full ROM w/ mid tendon
- Wall nods, backpedaling, heel raises with ball between heels
- Flexibility to the posterior chain and ankle DF
- Progress to higher level strengthening for the LE (squats, lunges, Y balance)
- Progress to sports specific drills
- Sensory:
- Balance retraining for control of ankle, as well as distal LE
- Air Ex pad, Rocker boards, wobble boards, Bosu ball
- Laser exercises
- Perturbations
- Balance and reach
- Y balance
- Single leg squatting and lunging as tolerated
Achilles Tendinopathy
Diagnosis = ?
Achilles Tendinopathy
- Symptoms located at 2-6 cm proximal to insertion.
- Decreased PF strength
- Royal London Hospital Test = Tenderness at 3 cm proximal to calcaneus with ankle in plantar flexion.
- Painful ARC
- Prognosis is good in 4-6 months with therapy
Who has insertional achilles tendinopathy = ?
Achilles Tendinopathy
Insertional Achilles Tendinopathy:
- Less active people
- Associated with retrocalcaneal bursitis, bony spurs, and Haglund Deformity
- Tend to have thickening of the tendon
- May not respond to eccentric lowering program = DON’T lower beyond the floor = poorer outcome
Should we only eccentrically load patients w/ achilles tendinopathy ?
Achilles Tendinopathy
Achilles Tendinopathy:
- DO NOT just isolate the tendon eccentrically
- Load the tendon appropriately what the patient can tolerate and progress the patient over time.
- Isometrics > Concentrics > Eccentrics
- To jumping/change of direction
- Load the patient as a whole with other exercises as needed.
Plantar Fasciitis
Pain Pattern & Examination = ?
Achilles Tendinopathy
Plantar Fasciitis - Pain Pattern:
- Pain over the inferior heel and plantar surface of the foot especially upon the first step in the morning.
- Heel pain worsens with increase in activity or with activity on hard surfaces.
- Examination:
- (+) Windless test
- Palpation of proximal plantar fascia
- Heel pain with first step is best predictor
Plantar Fasciitis
Risk factors & Observation = ?
Achilles Tendinopathy
Plantar Fasciitis - Risk Factors
- Decrease cross-section foot intrinsic muscle mass
- Limited Ankle DF ROM
- High BMI
- More common in females
- Abnormal FPI scores = Pes Cavus foot type, Pronated foot types, Hind foot varus
- Runners, Forklift drivers, assembly line workers on concrete
- Posterior chain tightness (Hamstrings Plantar flexion, & inversion movement)
- Using shoes with spikes during running
- Observation:
- Potentially Pronated feet or highly supinated feet
Manual therapy for plantar fasciitis should include = ?
Achilles Tendinopathy
Plantar Fasciitis - Manual Therapy:
- Bracing
- Initially boot may be necessary to control inflammation.
- Heel pads may or medial longitudinal arch supports may help short-term especially if taping provided relief.
- Night splints are another option
- Joint Mobilization:
- Ankle DF mob.
- Subtalar mob.
- Cross friction massage to Plantar Fascia
- Soft tissue MFR:
- Pin & stretch to plantar fascia and posterior chain
- Shockwave therapy
- Taping & orthotics (OTC just as effective as custom orthotics) may relieve acute pain.
Therapeutic exercise for plantar fasciitis should include = ?
Achilles Tendinopathy
Plantar Fasciitis - Therapeutic Exercise:
- Motor:
- Intrinsic foot strengthening (Short foot, abductor hallux and digiti minimi strengthening)
- Gastroc, Soleus, and Plantar Fascia & Stretching
- Flexibility to the posterior chain and ankle DF
- Weighted Heel raises/lower eccentrics
- Progress to higher level strengthening for the posterior tibialis, triceps surae, and entire LE (single leg heel raises, squats, lunges, Y balance)
- Progress to sports specific drills
- Sensory:
- Balance retraining for control of ankle, as well as distal LE
- Air Ex pad, Rocker boards, wobble boards, bosu ball
- Laser exercises
- Perturbations
- Balance and reach
- Y balance
- Single leg squatting & lunging as tolerated
Fasciitis / Heel Pain:
Risk factors & Diagnosis = ?
Achilles Tendinopathy
Fasciitis / Heel Pain:
- Risk factors:
- Decreased ankle dorsiflexion
- Decreased PF strength
- Decrease Toe flexor strength
- High BMI
- Diagnosis:
- First step pain is severe
- Pain with prolonged weight bearing later in the day
- (+) Windlass test
- (-) Tarsal Tunnel test
- Higher BMI
- 80% of people report resolution in 12 months
“A” Grade interventions for Heel Pain / Plantar Fasciitis = ?
Achilles Tendinopathy
Heel Pain/Plantar Fasciitis - Interventions:
- Manual therapy
- Stretching
- Taping
- Foot Orthoses
- Night Splints
Solution is to improve foot core strength = ?
Achilles Tendinopathy
Solution is to improve foot core strength:
- Doming/ Short Foot = Your arch should rise but your toes and the ball of your foot should remain firmly on the floor
- Toe spreading
- Toe extension
