Ankle: Pathologies 1 Flashcards
Achilles tendinopathy: mean age
30-50 yrs
Achilles tendinopathy: Tendon characteristics
Tendon thickening
Achilles tendinopathy: typical location
2-6 cm proximal to insertion
Achilles tendinopathy: strength deficits
- Decreased PF strength
- Decreased PF endurance
Achilles tendinopathy: ttp
Local tenderness of Achilles 2-6 cm proximal to insertion
Achilles tendinopathy: Pain/stiffness pattern with activity
- Pain and stiffness after INactivity
- Lessens with activity
- Returns after activity
Achilles tendinopathy: Pain with what specifically?
Eccentric DF (walking down stairs)
Achilles tendinopathy: Possible locations
Insertional
Noninsertional
Noninsertional Achilles tendinopathy occurs where?
6 cm proximal to insertion most commonly
Noninsertional Achilles tendinopathy commonly diagnosed how?
- Palpation
- Royal London Hospital Test
- arc sign
Insertional Achilles tendinopathy: occurs where
At tendon insertion on calcaneus
Achilles tendinopathy differential
- Tendon rupture
- Partial tear
- Retrocalcaneal bursitis
- Posterior impingement
- Os trigonum syndrome
- Calcaneal stress fx
- Talar fx
- Sural nerve irritability
- Radiculopathy
Achilles tendinopathy: % of runners that experience
11-57%
Achilles tendinopathy: % in non-athletes
2.9-4%
Prevalence in runners vs. non-athletes: odds ratio
10
Achilles tendinopathy: Annual incidence in elite runners
7-9%
Achilles tendinopathy: Increased incidence with… (nonmodifiable)
Age
Achilles tendinopathy: Age related morphological changes that occur
- inc collagen diameter
- dec glycosaminoglycan and H2O
- dec tensile strength, stiffness, and load
- dec capacity for collagen synthesis
Achilles tendinopathy: Why might an increase in neovascular growth cause this?
Increased nerve fascicles which may induce pain
Achilles tendinopathy: Etiology overall
- Degenerative process
- Age induced morphological changes
- Neovascular growth
Non-insertional Achilles tendinopathy: risk factors
What are the intrinsic factors?
- Dorsiflexion ROM
- Abnormal subtalar ROM
- Decreased PF strength
- Excessive pronation
- Hallux rigidis
Non-insertional Achilles tendinopathy: risk factors
Intrinsic: DF ROM
DF < 11.5˚
Non-insertional Achilles tendinopathy: risk factors
DF ROM < 11.5˚ increased risk by a factor of
3.5
Non-insertional Achilles tendinopathy: risk factors
Abnormal subtalar ROM:
- Increased inversion ROM > 32.5˚
- Decreases in total inv/ev ROM (<25˚)
Non-insertional Achilles tendinopathy: risk factors
Abnormal subtalar ROM: Increased inversion ROM increased risk by a factor of
2.8
Non-insertional Achilles tendinopathy: risk factors
Extrinsic factors
- Training errors
- Footwear
Non-insertional Achilles tendinopathy: risk factors
Extrinsic factors:
Training errors
- Inc mileage
- Inc intensity
- Hill training
Non-insertional Achilles tendinopathy: risk factors
Extrinsic factors:
Footwear
- Insufficient rearfoot control
- Hard soles
- High heels
Nonmodifiable risk factors for non-insertional Achilles tendinopathy
- Age
- Obesity
Patients who are obese have been found to be __x more likely to have noninsertional Achilles tendinopathy than those with normal BMI
2.6 - 6.6x more likely
Strong evidence to support this type of intervention in the treatment of Achilles tendinopathy
Eccentric loading
Eccentric loading protocols for Achilles tendinopathy:
- Curwin and Stannish
- Alfredson et al
Eccentric loading protocols for Achilles tendinopathy:
Curwin and Stanish protocol
3 x 10 reps
Increased load weekly
Movement speed changed daily
Eccentric loading protocols for Achilles tendinopathy:
Curwin and Stanish
(%) of pts reported symptom resolution in 6-8 weeks
95%
Eccentric loading protocols for Achilles tendinopathy:
Alfredson protocol
3 x 15 reps
2x per day
12 weeks
UNILATERAL heel raises with NO concentric component
Achilles tendinopathy: most patients appear to improve within (timeframe)
3-6 mos
Achilles tendinopathy: In general, tendons are not inflamed as much as ___
Thickened
Insertional Achilles tendinopathy: often accompanied by…
- Bursitis
- Bone spurs
- Haglund’s deformity
Insertional Achilles tendinopathy:
Haglunds deformity aka
Pump bump
Insertional Achilles tendinopathy:
Most frequently occurs in what groups?
- Sedentary
- Often overweight
Insertional Achilles tendinopathy: Treatment
- Eccentric heel lowering
- Address DF limitations
Insertional Achilles tendinopathy: modifications to tx for sedentary individuals
Limited heel lowering at first
Likely have DF limitation
Achilles tendon rupture: Increasing incidence due to
- Increased sport participation in adults
- Adults living with chronic disease and DM
Achilles tendon rupture: most frequently occur in males between what ages?
40-60
Achilles tendon rupture: how many times more likely to occur in males age 40-60?
3-4x
Achilles tendon rupture: Diagnosis
+ Thompson test
Dec PF strength
Palpable defect in tendon
Inc DF ROM
Achilles tendon rupture: treatment
Make sure to maintain what?
Mobility of toes
Foot intrinsic strength
Achilles tendon rupture: treatment
This results in improved satisfaction and earlier return to work
Early/immediate FWB
Achilles tendon rupture: treatment
Bruman protocol recommends
- Ankle immobilized in PF with WB
- 3 weeks of 0-30˚ of PF immobilized
- 7 weeks full ROM without immobilization
Achilles tendon rupture: treatment
More conservative approaches may include orthoses up to (time)
16 weeks
