Foot pain

Question 1

Achillies tendon : Anaomty

Answer 1

1. The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel (the calcaneus bone).

2 . Flexion of the calf muscles pulls on the Achilles and causes plantar flexion of the ankle.

Question 2

Achilles tendinopathy : Definition

Answer 2

Achilles tendinopathy involves damage, swelling, inflammation and reduced function in the Achilles tendon.

Question 3

Achilles tendinopathy : Clinical features

Answer 3

The typical presentation is with a gradual onset of:
* Pain or aching in the Achilles tendon or heel, with activity
* Stiffness
* Tenderness
* Swelling
* Nodularity on palpation of the tendon

Question 4

Achilles tendinopathy : Management

Answer 4

• Rest and altered activities
• Physiotherapy
• Orthotics (e.g., insoles)

Steroid injections into the Achilles tendon are avoided due to the risk of tendon rupture.

Question 5

Achillies tendon pathology : Risk factors

Answer 5

• Sports that stress the Achilles
• Inflammatory conditions (e.g., rheumatoid arthritis and ankylosing spondylitis)
• Diabetes
• Raised cholesterol
• Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin0 : within 48 hours of initiating

Question 6

Achilies tendon rupture : Clinical features

Answer 6

The typical presentation is:
* Sudden onset of pain in the Achilles or calf
* A snapping sound and sensation
* Feeling as though something has hit them in the back of the leg

Clinical signs;
Tenderness, palpable gap in the achillies tendon
Simmond’s calf squeeze test :
1. Squeeze calf when patient’s feet are dangling off the bed
2. Normally should initate plantar flexion - in a damaged achilies tendon the connection between the ankle and calf is lost
3. Lack of plantar flexion } confirms Achillies tendon rupture

Question 7

Achilies tendon rupture : Investigations

Answer 7

Ultrasound is the investigation of choice for confirming the diagnosis.

Question 8

Achilies tendon rupture : Management

Answer 8

Surgical management
1. involves surgically reattaching the Achilles.
2. After surgery, a similar process is followed to non-surgical management;
* boots that immobilise the ankle initially in a plantar-flexed position, gradually adjusted to a neutral position.