Achilles Tendinopathy

Question 1

Definition

Answer 1

Common overuse injury with risk factor of lack of flexibility or stiff achilles tendon

Question 2

Risk Factors

Answer 2

Foot overpronation, acute overload, blunt trauma, acute muscle fatigue, obesity, high BP, DM2, prolonged steroid use, family history, inappropriate footwear, and elderly population

Question 3

Clinical Presentation

Answer 3

Morning pain**, sensitivity of tendon, stiffness

Question 4

Examination

Answer 4

Muscle atrophy, swelling, asymmetry, erythema, limited ROM, tenderness to palpation, heel varus, pes planus, foot pronation, positive arc sign

Question 5

Arc Sign

Answer 5

Patient prone with ankles hanging off table, palpate achilles tendon in distal to proximal direction (feeling for localized thickening of tendon), fingers stay on area while patient DF/PF foot, (+) = area of swelling moves when patient DF/PF

Question 6

Outcome Measure

Answer 6

LEFS (not achilles specific) and VISA-A (achilles specific self reported outcome measure for severity)

Question 7

PT Management

Answer 7

Heel lifts, progressive tendon loading (less burdening activities so burden on tendon decreases but complete immobilization will cause atrophy), functional strength training to reduce tendon pain, eccentric strength training, isometric loading (double or single leg calf holds), isotonic loading (seated calf raises with gradual increase to standing), and energy storage loading (double leg hop, single leg hop, hopscotch)