Lecture 14: lower leg issues and knee anatomy part 1

Question 1

what is the thickest and strongest tendon in the body?

Answer 1

the achilles

Question 2

achilles - the facts

Answer 2

• achilles tendon has no synovial sheath but is surrounded by paratendon
• only vascular tendons are surrounded by paratendon

Question 3

posterior heel pain

Answer 3

could be either:
1: achilles tendonitis
2: achilles bursitis
3: Retrocalcaneal bursitis

• true tendon pain is usually confined to the tendon itself

Question 4

retrocalcaneal bursitis

Answer 4

• bursa in the recess between the anterior inferior side of the achilles tendon and the posterosuperior aspect of the calcaneus (retrocalcaneal recess)
• sometimes seen with insertional tendinopathy
• structural irritants (tight/pokey)
• pain just above the insertion of the achilles tendon
• pain with squeeze from side

Question 5

what is the difference between achilles bursitis and retrocalcaneal Bursitis

Answer 5

1: retrocalcaneal bursitis: pain with squeeze from side

2: achilles bursitis (superficial calcaneal bursitis): pain posterior aspect of heel with solid swelling

Question 5

achilles bursitis

Answer 5

• superficial calcaneal bursitis (wearing shoes that are too big or too tight)
• bursa located between calcaneal prominence or the achilles tendon and the skin
• pain posterior aspect of heel with solid swelling
• often due to excessive friction or by wearing shoes that are too tight or too large

Question 6

management of an “ITIS”

Answer 6

• POLICE/PEACE & LOVE
• addressing training and equipment issues
• heel lift? (will help with taking it off stretch so the person should feel better)
• pad? (use a donut pad to take pressure off the middle
• achilles stretch
• new shoes/ popped out

Question 7

a bent knee stretches — and a straight leg stretches —

Answer 7

1: soleus

2: gastric as it crosses the knee

Question 8

tendinitis/paratenonitis

Answer 8

• tendinitis - is inflammation of the tendon itself and is relatively rate
• paratenonitis - inflammation, pain, and crepitation of the paratendon as it slides over the structure
• acute irritation

Question 9

external factors of tendinitis/ paratenonitis

Answer 9

• rub from shoe/equipment
• running down hill-tibialis anterior
• rub from laces - Tibialis anterior
• hyper dorsiflexion- achilles
• having high or low arches

Question 10

internal factors (such as foot malalignment) of tendinitis/paratenonitis

Answer 10

• rub over bone
• cavus or flat/pronating feet

Question 11

signs and symptoms of tendinitis/paratenonitis

Answer 11

• pain and/or crepitation (of paratenon) of acute onset
• red and hot over involves structure
• usually precipitated by movement around the ankle joint - remember too much, too soon!

Question 12

diagnosis of tendinitis/paratenonitis

Answer 12

• made on the basis of local swelling
• selective tissue tension testing (making them contract as the agonist, resisted testing, or stretch it as the antagonist group in active range of motion)
• palpation over structures

Question 13

paratenonitis rehabilitation

Answer 13

1: inflammatory/destructive
- red, hot, painful, swelling
plan: POLICE/ PEACE & LOVE
- heel lift/ pad/ support

2: repair
pain, swelling subsides, tissue healing
- heat
- idealize ROM - stretch Gastrocs and soleus
- start strength and proprioception exercise as able
- address training issues

3: remodeling phase
realign and prepare for return
- idealize strength
- soft tissue work, to realign fibers
- begin speed and power training

Question 14

what is tendinosis/tendinopathy

Answer 14

• chronic pathological changes brought about by repetitive micro-trauma
• inflammatory cells are absent ( not red and not hot)
• characteristics changes in collagen fiber structures
• abnormal (poor) vascularity