problems with Achilles Flashcards
what is the function of the Achilles tendon?
- connects calf muscles- gastrocnemius and soles to the calcareous bone
- flexion of calf muscle causes plantar flexion and stretching of the achillies tendon
what are the 2 types of Achilles tendonopathy?
Insertion tendinopathy (within 2cm of the insertion point on the calcaneus)
Mid-portion tendinopathy (2-6 cm above the insertion point)
what are risk factors for achillies tendonitis?
Sports that stress the Achilles (e.g., basketball, tennis and track athletics)
Inflammatory conditions (e.g., rheumatoid arthritis and ankylosing spondylitis)
Diabetes
Raised cholesterol
Fluoroquinolone antibiotics (e.g., ciprofloxacin and levofloxacin)
what is the presentation of achillies tendonitis?
Pain or aching in the Achilles tendon or heel, with activity
Stiffness
Tenderness
Swelling
Nodularity on palpation of the tendon
what is the special test to check for achillies tendon rupture?
Simmonds calf squeeze test- if there is no rupture calf squeeze will cause foot to plantar flex
how can you diagnose achillies tendon rupture?
USS
why are steroid injections avoided in achillies tendonitis?
risk of tendon rupture
what are management options for achillies tendonitis?
Rest and altered activities
Ice
Analgesia
Physiotherapy
Orthotics (e.g., insoles)
Extracorporeal shock-wave therapy (ESWT)
Surgery, to remove nodules and adhesions or alter the tendon, may be used where other treatments fail
how quickly can achillies tendon rupture happen after starting quinolone antibiotic?
48 hours
what are signs of achillies tendon rupture on examination?
When relaxed in a dangled position, the affected ankle will rest in a more dorsiflexed position
Tenderness to the area
A palpable gap in the Achilles tendon (although swelling might hide this)
Weakness of plantar flexion of the ankle (dorsiflexion is unaffected)
Unable to stand on tiptoes on the affected leg alone
Positive Simmonds’ calf squeeze test
what should you consider when mobilising the ankle?
VTE prophylaxis
what is non surgical management for a ruptured achillies tendon?
he first boot involves full plantar flexion of the ankle. Over time, the boots are altered to gradually move the ankle from full plantar flexion to a neutral position.
This process takes 6-12 weeks while the Achilles tendon heals. A long rehabilitation process is required to get back to full pre-injury function.
what is surgical management for ruptured Achilles tendon?
Surgical management involves surgically reattaching the Achilles.
After surgery, a similar process is followed to non-surgical management, with boots that immobilise the ankle initially in a plantar-flexed position, gradually adjusted to a neutral position. This is followed by a long rehabilitation process to get back to full pre-injury function.
