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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

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
Non-insertional Achilles tendinopathy: risk factors | Abnormal subtalar ROM: Increased inversion ROM increased risk by a factor of
2.8
26
Non-insertional Achilles tendinopathy: risk factors | Extrinsic factors
- Training errors | - Footwear
27
Non-insertional Achilles tendinopathy: risk factors Extrinsic factors: Training errors
- Inc mileage - Inc intensity - Hill training
28
Non-insertional Achilles tendinopathy: risk factors Extrinsic factors: Footwear
- Insufficient rearfoot control - Hard soles - High heels
29
Nonmodifiable risk factors for non-insertional Achilles tendinopathy
- Age | - Obesity
30
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
31
Strong evidence to support this type of intervention in the treatment of Achilles tendinopathy
Eccentric loading
32
Eccentric loading protocols for Achilles tendinopathy:
- Curwin and Stannish | - Alfredson et al
33
Eccentric loading protocols for Achilles tendinopathy: | Curwin and Stanish protocol
3 x 10 reps Increased load weekly Movement speed changed daily
34
Eccentric loading protocols for Achilles tendinopathy: Curwin and Stanish (%) of pts reported symptom resolution in 6-8 weeks
95%
35
Eccentric loading protocols for Achilles tendinopathy: | Alfredson protocol
3 x 15 reps 2x per day 12 weeks UNILATERAL heel raises with NO concentric component
36
Achilles tendinopathy: most patients appear to improve within (timeframe)
3-6 mos
37
Achilles tendinopathy: In general, tendons are not inflamed as much as ___
Thickened
38
Insertional Achilles tendinopathy: often accompanied by...
- Bursitis - Bone spurs - Haglund’s deformity
39
Insertional Achilles tendinopathy: | Haglunds deformity aka
Pump bump
40
Insertional Achilles tendinopathy: | Most frequently occurs in what groups?
- Sedentary | - Often overweight
41
Insertional Achilles tendinopathy: Treatment
- Eccentric heel lowering | - Address DF limitations
42
Insertional Achilles tendinopathy: modifications to tx for sedentary individuals
Limited heel lowering at first | Likely have DF limitation
43
Achilles tendon rupture: Increasing incidence due to
- Increased sport participation in adults | - Adults living with chronic disease and DM
44
Achilles tendon rupture: most frequently occur in males between what ages?
40-60
45
Achilles tendon rupture: how many times more likely to occur in males age 40-60?
3-4x
46
Achilles tendon rupture: Diagnosis
+ Thompson test Dec PF strength Palpable defect in tendon Inc DF ROM
47
Achilles tendon rupture: treatment | Make sure to maintain what?
Mobility of toes | Foot intrinsic strength
48
Achilles tendon rupture: treatment | This results in improved satisfaction and earlier return to work
Early/immediate FWB
49
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
50
Achilles tendon rupture: treatment | More conservative approaches may include orthoses up to (time)
16 weeks

OPTIM OCS: LQ (43 decks)

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