Achilles Tendinopathy

Question 1

What is the prevelence and incidence of achilles tendinopathy?

Answer 1

• Prevalence of 11-57% in runners compared to 2.9-4% of non-athletes with an odds ratio of 10.0 (significa que os atletas contraem 10 vezes mais a condição)
• Annual incidence of 7-9% in elite runners
• Increased incidence of Achilles injury as age increases
• 7/100,000 general population
• 12/100,000 in competitive athletes

Question 2

What is behind the etiology of the achilles tendinopathy?

Answer 2

• Degenerative Process
• Achilles tendon undergoes morphologic and biomechanical changes with increasing age
• Decreased capacity for collagen synthesis
• Abnormal neovascularization which may be accompanied by an in-growth of nerve fascicles which may in part be responsible for the pain associated with Achilles tendinopathy.

Question 3

Quais os fatores mecânicos e estrutuais que podem estar envolvidos nesta condição clínica?

Answer 3

• Mechanical factors: Repetitive mechanical loads, excessive loads, contusions.
• Structural factors: Morphologic, cellular, metabolic.

Question 4

Que alterações morfológicas e biomecânicas ocorrem com a idade?

Answer 4

• Decreased collagen diameter/density
• Decreased glycosaminoglycans and water content
• Increased nonreducible cross links
• Decreased tensile strength, linear stiffness, and ultimate load.

Question 5

List some of the features present in achilles tendinopathy.

Answer 5

• Mean age 30-50 years
• Athletic – Running, Jumping
• Local tenderness of the Achilles 2-6cm proximal to its insertion
• Tendon thickening
• Decreased PF strength
• Decreased PF endurance
• Pain and stiffness after inactivity, lessens with activity and returns after activity
• Pain with eccentric DF (walking down stairs).

Question 6

Appoint some intrinsic risk factors of achilles tendinopathy.

Answer 6

• Dorsiflexion ROM – Decreased (inf 11.5 degrees) increased risk by a factor of 3.5
• Abnormal subtalar ROM – Increased inversion ROM (>32.5 degrees) increased risk by a factor of 2.8 ; Decreases in total inversion/eversion ROM (<25 degrees)
• Decreased Plantar Flexion Strength
• Excessive pronation
• Hallux rigidis.

Question 7

Exemplify some extrensic factors.

Answer 7

• Training Errors – Increased mileage, intensity, hill training
• Footwear with insufficient rearfoot control, hard soles, or high heels.

Question 8

Quais os pontos chave que ajudam a diagnosticar tendinopatia do aquiliano?

Answer 8

• Symptoms located to the midportion of the Achilles tendon
• Intermittent pain related to exercises or activity
• Stiffness upon weight bearing after prolonged immobility such as sleeping
• Stiffness and pain at the commencement of an exercise training session that lessens as exercise continues
• Achilles tendon tenderness.