Mid-Portion Achilles Tendinopathy

Question 1

Describe the location of a mid-portion achilles tendinopathy…

Answer 1

2-3cm above the achilles insertion.

Question 2

What are the risk factors for achilles tendinopathy?

Answer 2

• Sudden increases in physical activity (previous 3-4 months)
• Running athletes/recreational activity
• Flat foot/high arch
• Reduced ankle dorsiflexion

Question 3

What symptoms will the patient likely report in the subjective assessment?

Answer 3

• Gradual worsening of symptoms
• Pain 2-3 cm above tendon insertion
• Pain (usually) worst in morning or after long periods of inactivity.
• MAY not periods of swelling
• MAY note feeling of stiffness

Question 4

What would you likely observe in the objective assessment?

Answer 4

• Palpable nodules OR thickening of tendon.
• +ve Royal London Hospital Test
• Crepitus with movement into PF/DF
• +ve Single Leg heel raise (sedentary) or Hop Test (active)

Question 5

What are the treatment options for Achilles tendinopathy?

Answer 5

• If in acute stages - de-load
  immediately for 2 weeks
• If chronic stages (likely) - continue with exercise to pain tolerance

- Begin loading with calf raises - high load (slow reps
slow reps (emphasis on BOTH eccentric and concentric)

• Ankle mobilisations (dorsiflexion)
• Consider orthotics if over-pronating
• Consider weight-loss strategies

Question 6

What is the key differential diagnosis?

Answer 6

Posterior impingement

Question 7

What are the key differences in presentation between Achilles tendinopathy and posterior impingement?

Answer 7

• Ankle pain is usually posterior to lateral malleolus, instead of on Achilles.
• Pain with end range PF in impingement.
• Positive posterior impingement test.