achilles tendinopathy - final exam Flashcards by Demond Fleming

What is the most frequently reported overuse injury?

achilles tendinopathy

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who is Achilles tendinopathy most common in?

recreational/competitive activities
training > competition
30-50 year olds
10-20% of runners

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risk factors and etiology of achilles tendinopathy:
- reduced ____ ROM that limits PE of Achilles
- limited ______ flexibility
- ______ weakness
- _____ gender and ______ age
- abnormal _______
- what about weight?
- 3 things to consider:

DF
calf
calf
male and older
tendon structure
obesity
training errors, environmental factors, improper shoes

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risk factors of achilles tendinopathy : L4-S1 regional interdependence
– excessive _______ with tendinopathy origins due to Achilles attaching more ______ of calcaneus
– ____ neuromuscular deficits
– _______ deficits

EV/pronation; medial
hip
balance

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pathomechanics of achilles tendinopathy:
- repetitive _______ with compression from limited _____ and/or excessive _______
- lack of PE with limited DF so ______

lengthening
DF
EV
overworked

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achilles tendinopathy can occur from collagen fibril ______/________ and fibroblast _____ from:
- altered fluid movement leads to _____
- increased nitric acid with _______

thinning/disorganization
death
- overheating
- persistent inflammation

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with achilles tendinopathy, you get a thickened but weaker tendon from:

increase of non-collagen matrix
fat deposition

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achilles tendinopathy can result from ineffective ______ and impaired _______

force transfer
motor control

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symptoms of achilles tendinopathy

gradual onset that limits WB activity
localized P! and stiffness
- particularly after inactivity
- lessens with mild bout of activity
- increase with moderate to severe activity

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signs of achilles tendinopathy:
- observation:
- ROM:
- resisted:
- accessory motion

achilles thickening. possible impaired LE control
possible P! and limitation with DF
possible P! with PF; may be weak. possibly hip and knee weakness of antigravity muscles
possible talar hypomobility for DF

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Achilles tendinopathy special tests:

palpate tender area; ask pt to DF/PF ankle
(+) = ?

arc sign
(+) = tender area moves with DF and PF

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achilles tendinopathy special tests:

palpate tender area; ask pt to DF ankle
(+) ?

royal london
(+) = tender area less tender in DF

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what are two other more functional tests for achilles tendinopathy?

single leg heel raise for endurance (if more P! on incline –> plantaris and insertional injury)
single leg hop
both (+) = less reps vs uninvolved side

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muscle length test for achilles tendinopathy?

shortened gastrocs

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where is TTP for achilles tendinopathy?

2-6 cm proximal to insertion

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achilles pain would be more _____ indicating plantaris involved

medial

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what are some differential dx at posterior ankle?

achilles/fascial tears
calcaneal bursitis
plantaris tendinopathy
posterior ankle impingement

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what should you educate your patient on for PT Rx for achilles tendinopathy?

rest NOT indicated
optimal stress is best within appropriate P! levels
weight management
shoe wear
timeline (8-12 weeks)
prognosis (80% progress)

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effectiveness of modalities for achilles tendinopathy?
- LASER
- Ionto
- shockwave therapy

contradictory evidence
dexamethasone helpful for P! and function
more P! relief w ADLs when added to 4 weeks of exercise. no structural changes

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PT Rx effectiveness for achilles tendinopathy: Bracing and taping
- neoprene sleeves:
- night splint:
- kinesiotape:

anecdotal
not beneficial and no support
anecdotal and conflicting

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arch taping for achilles tendinopathy may help predict ______
shock absorbing orthotic _______ rate of injury
heel lift support ?

orthotic benefit
decreased
mixed support

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PT Rx effectiveness for achilles tendinopathy:
- dry needling:
- STM:
- gentle stretching:
- JMs:

helpful for pain when added to exercise
anecdotal. helpful for motion w exercise
weak support. may be contraindicated due to higher tension/compression on tendon
for mobility and function

primary purposes MET for achilles tendinopathy

tendon proliferation and stabilization

PT Rx MET muscle actions for achilles tendinopathy:
- ______ only
- _________ and ______ concentrics/eccentrics

eccentrics
heavy and slow

what exercises would you prescribe for someone with achilles tendinopathy?

PF w knee flexed PF w knee ext heel raises legs straight and bent

how do you progress resistance and activity for achilles tendinopathy?

add weight in hand or with loaded backpack leg press or heel raise machine sitting or standing heel raises

timeline for achilles tendinopathy Rx:

at least 2x/week, recommend every other day 6-12 weeks may need more recovery time between heavy loading in a non-athletic/older patient once symptoms return to normal P!, repeat exercises

recurrence rate for achilles tendinopathy:

27%

prognosis for achilles tendinopathy: - mostly normalized ____ and _____ - improved: - _____ weeks to recovery - _____% recovered with ______ months of progressive loading at a 5 year follow up

tendon structure and thickness mechanical properties as well as cortical function 12 80%; 3-6 months

with eccentric exercises, ______% success for mid portion tendinopathy in athletes ______% sedentary individuals _____% insertional tendinopathy

82-100% 60% < 32%

mild pain may remain in ____% with achilles tendinopathy

20-45%

MD Rx achilles tendinopathy: - mid portion: - insertional:

- insufficient evidence for cortisone - guided cortisone effective for P! and function. recommended for non athletic pop.

calcaneal apophysitis or Sever's Disease most common in:

9-12 year old boys

etiology of severs disease:

growth with high activity

pathomechanics of severs disease:

leg bone growth exceeds PF lengthening increased tendon tension growth plate is weak spot mostly inflammation complications: avulsion or premature closure

risk factors of severs disease

long or year round sports poor fitting shoes that lack cushion training errors shortened PFs foot dysfunction; pes planus/cavus

risk factors of severs disease

long or year round sports poor fitting shoes that lack cushion training errors shortened PFs foot dysfunction; pes planus/cavus

symptoms of severs disease

gradual onset of heel P! with overuse bilateral (60%) because equally walking on feet

ROM for Severs disease:

limited DF leading to greater tensile forces on growth plate

special tests for severs disease:

squeeze test on heel severs sign: P! with heel raise m length: shortened gastroc

where would be TTP w severs disease

cap of calcaneus

PT Rx for severs disease:

patient education policed U shaped foam upside down on achilles w ankle sleeve restore DF ROM/accessory motion

what stretching would you do for severs disease?

hamstring stretching due to fascial connections w gastroc be careful with prolonged calf stretches

PT Rx severs disease: orthotics - arch support for _____ - ______ > arch supports -- gel heel cups with a lift work __

- excessive pronation - heel lifts -- best

MET Rx for severs disease

any impaired LQ control caution with muscle/tendon attached to growth plate to avoid greater overuse

prognosis for severs disease: - ___ resolved at 1 month; ___ at 3 months - can be a ____ and/or ____ problem - growth plate closes around _____

- 75%; 95% - recurrent/persistent - 14 years

achilles rupture prevalence:

men ages 20-50

where would the achilles typically rupture

3-4 cm proximal to calcaneal insertion

how would an achilles rupture typically happen

during a sudden eccentric activity

Signs of achilles rupture: - ROM/resisted: - special tests:

- limited if any PF/ weak PF - 1. Matle's: prone, knee 90 deg flx, (+) = foot neutral or DF 2. tendon gap palpation 3. thompson: in supine squeeze calf

PT Rx for achilles rupture:

POLICED like achilles tendinopathy

early functional rehab and WB for achilles rupture: - Week 0-2 - week 3-6 - week 7

- ROM: none orthosis: fixed @ 30 deg PF - ROM: up to 30 deg DF; free PF orthosis: 30 PF to 0 DF - normal

prognosis for achilles rupture:

many professional athletes don't return to prior levels