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OPTIM OCS: LQ > Ankle: Pathologies 1 > Flashcards

Ankle: Pathologies 1 Flashcards

1
Q

Achilles tendinopathy: mean age

A

30-50 yrs

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2
Q

Achilles tendinopathy: Tendon characteristics

A

Tendon thickening

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3
Q

Achilles tendinopathy: typical location

A

2-6 cm proximal to insertion

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4
Q

Achilles tendinopathy: strength deficits

A
  • Decreased PF strength

- Decreased PF endurance

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5
Q

Achilles tendinopathy: ttp

A

Local tenderness of Achilles 2-6 cm proximal to insertion

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6
Q

Achilles tendinopathy: Pain/stiffness pattern with activity

A
  • Pain and stiffness after INactivity
  • Lessens with activity
  • Returns after activity
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7
Q

Achilles tendinopathy: Pain with what specifically?

A

Eccentric DF (walking down stairs)

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8
Q

Achilles tendinopathy: Possible locations

A

Insertional

Noninsertional

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9
Q

Noninsertional Achilles tendinopathy occurs where?

A

6 cm proximal to insertion most commonly

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10
Q

Noninsertional Achilles tendinopathy commonly diagnosed how?

A
  • Palpation
  • Royal London Hospital Test
  • arc sign
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11
Q

Insertional Achilles tendinopathy: occurs where

A

At tendon insertion on calcaneus

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12
Q

Achilles tendinopathy differential

A
  • Tendon rupture
  • Partial tear
  • Retrocalcaneal bursitis
  • Posterior impingement
  • Os trigonum syndrome
  • Calcaneal stress fx
  • Talar fx
  • Sural nerve irritability
  • Radiculopathy
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13
Q

Achilles tendinopathy: % of runners that experience

A

11-57%

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14
Q

Achilles tendinopathy: % in non-athletes

A

2.9-4%

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15
Q

Prevalence in runners vs. non-athletes: odds ratio

A

10

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16
Q

Achilles tendinopathy: Annual incidence in elite runners

A

7-9%

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17
Q

Achilles tendinopathy: Increased incidence with… (nonmodifiable)

A

Age

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18
Q

Achilles tendinopathy: Age related morphological changes that occur

A
  • inc collagen diameter
  • dec glycosaminoglycan and H2O
  • dec tensile strength, stiffness, and load
  • dec capacity for collagen synthesis
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19
Q

Achilles tendinopathy: Why might an increase in neovascular growth cause this?

A

Increased nerve fascicles which may induce pain

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20
Q

Achilles tendinopathy: Etiology overall

A
  • Degenerative process
  • Age induced morphological changes
  • Neovascular growth
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21
Q

Non-insertional Achilles tendinopathy: risk factors

What are the intrinsic factors?

A
  • Dorsiflexion ROM
  • Abnormal subtalar ROM
  • Decreased PF strength
  • Excessive pronation
  • Hallux rigidis
22
Q

Non-insertional Achilles tendinopathy: risk factors

Intrinsic: DF ROM

A

DF < 11.5˚

23
Q

Non-insertional Achilles tendinopathy: risk factors

DF ROM < 11.5˚ increased risk by a factor of

A

3.5

24
Q

Non-insertional Achilles tendinopathy: risk factors

Abnormal subtalar ROM:

A
  • Increased inversion ROM > 32.5˚

- Decreases in total inv/ev ROM (<25˚)

25
Q

Non-insertional Achilles tendinopathy: risk factors

Abnormal subtalar ROM: Increased inversion ROM increased risk by a factor of

A

2.8

26
Q

Non-insertional Achilles tendinopathy: risk factors

Extrinsic factors

A
  • Training errors

- Footwear

27
Q

Non-insertional Achilles tendinopathy: risk factors
Extrinsic factors:
Training errors

A
  • Inc mileage
  • Inc intensity
  • Hill training
28
Q

Non-insertional Achilles tendinopathy: risk factors
Extrinsic factors:
Footwear

A
  • Insufficient rearfoot control
  • Hard soles
  • High heels
29
Q

Nonmodifiable risk factors for non-insertional Achilles tendinopathy

A
  • Age

- Obesity

30
Q

Patients who are obese have been found to be __x more likely to have noninsertional Achilles tendinopathy than those with normal BMI

A

2.6 - 6.6x more likely

31
Q

Strong evidence to support this type of intervention in the treatment of Achilles tendinopathy

A

Eccentric loading

32
Q

Eccentric loading protocols for Achilles tendinopathy:

A
  • Curwin and Stannish

- Alfredson et al

33
Q

Eccentric loading protocols for Achilles tendinopathy:

Curwin and Stanish protocol

A

3 x 10 reps
Increased load weekly
Movement speed changed daily

34
Q

Eccentric loading protocols for Achilles tendinopathy:
Curwin and Stanish

(%) of pts reported symptom resolution in 6-8 weeks

A

95%

35
Q

Eccentric loading protocols for Achilles tendinopathy:

Alfredson protocol

A

3 x 15 reps
2x per day
12 weeks

UNILATERAL heel raises with NO concentric component

36
Q

Achilles tendinopathy: most patients appear to improve within (timeframe)

A

3-6 mos

37
Q

Achilles tendinopathy: In general, tendons are not inflamed as much as ___

A

Thickened

38
Q

Insertional Achilles tendinopathy: often accompanied by…

A
  • Bursitis
  • Bone spurs
  • Haglund’s deformity
39
Q

Insertional Achilles tendinopathy:

Haglunds deformity aka

A

Pump bump

40
Q

Insertional Achilles tendinopathy:

Most frequently occurs in what groups?

A
  • Sedentary

- Often overweight

41
Q

Insertional Achilles tendinopathy: Treatment

A
  • Eccentric heel lowering

- Address DF limitations

42
Q

Insertional Achilles tendinopathy: modifications to tx for sedentary individuals

A

Limited heel lowering at first

Likely have DF limitation

43
Q

Achilles tendon rupture: Increasing incidence due to

A
  • Increased sport participation in adults

- Adults living with chronic disease and DM

44
Q

Achilles tendon rupture: most frequently occur in males between what ages?

A

40-60

45
Q

Achilles tendon rupture: how many times more likely to occur in males age 40-60?

A

3-4x

46
Q

Achilles tendon rupture: Diagnosis

A

+ Thompson test
Dec PF strength
Palpable defect in tendon
Inc DF ROM

47
Q

Achilles tendon rupture: treatment

Make sure to maintain what?

A

Mobility of toes

Foot intrinsic strength

48
Q

Achilles tendon rupture: treatment

This results in improved satisfaction and earlier return to work

A

Early/immediate FWB

49
Q

Achilles tendon rupture: treatment

Bruman protocol recommends

A
  • Ankle immobilized in PF with WB
  • 3 weeks of 0-30˚ of PF immobilized
  • 7 weeks full ROM without immobilization
50
Q

Achilles tendon rupture: treatment

More conservative approaches may include orthoses up to (time)

A

16 weeks

OPTIM OCS: LQ (43 decks)

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