Achilles Tendinopathy: Difference between revisions
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== Clinically Relevant Anatomy<br> == | == Clinically Relevant Anatomy<br> == | ||
The Achilles tendon is the single tendon of the soleus and gastrocnemius muscles, inserting into the calcaneus.<ref>Cook JL, Khan KM, Purdam C. Achilles tendinopathy. Manual Therapy 2002;7(3):121-130.</ref><br> | The Achilles tendon is the single tendon of the soleus and gastrocnemius muscles, inserting into the calcaneus.<ref name="1">Cook JL, Khan KM, Purdam C. Achilles tendinopathy. Manual Therapy 2002;7(3):121-130.</ref><br> | ||
== Mechanism of Injury / Pathological Process<br> == | == Mechanism of Injury / Pathological Process<br> == | ||
Achilles tendonitis is commonly seen in athletes who sustain an increase in training load, and is most often due to overuse. Tendons respond poorly to overuse, therefore healing is slow. This can leave a tendon pathologically substantially defective, which decreases tendon strength and leaves it less able to tolerate load, thus vulnerable to further injury. | Achilles tendonitis is commonly seen in athletes who sustain an increase in training load, and is most often due to overuse. Tendons respond poorly to overuse, therefore healing is slow. This can leave a tendon pathologically substantially defective, which decreases tendon strength and leaves it less able to tolerate load, thus vulnerable to further injury.<ref name="1" /> Extrinsic factors contributing to this condition include training errors and inappropriate footwear. Intrinsic factors include inflexibility, weakness and malalignment.<ref name="2">Roos EM, Engstrom M, Lagerquist A, Soderberg B. Clinical improvement after 6 weeks of eccentric exercise in patients with mid-portion Achilles tendinopathy - a randomized trial with 1-year follow-up. Scand J Med Sci Sports. 2004;14:286-295.</ref><br> | ||
== Clinical Presentation == | == Clinical Presentation == | ||
Morning pain is a hallmark symptom because the Achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes.<ref name="1" /><br> | |||
== Diagnostic Procedures == | == Diagnostic Procedures == | ||
Imaging studies are not necessary to diagnose Achilles tendonitis, but may be useful with differential diagnosis. US is the imaging modality of first choice as it provides a clear indication of tendon width, changes of water content within the tendon and collagen integrity, as well as bursal swelling. MRI may be indicated if diagnosis is unclear or symptoms are atypical. MRI may show increased signal within the Achilles. <br> | |||
== Outcome Measures == | == Outcome Measures == | ||
Robinson et al recommend the VISA-A scale. This is a subjective rating scae that quantifies the symptoms and dysfunction in the Achilles tendon. It is very useful to rate Achilles tendons and to assess progress of recovery during rehabilitation. | |||
<ref name="1" /><ref name="3">Robinson JM, Cook JL, Purdam C et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. British J of Sports Med. 2001;35:335-341.</ref> | |||
== Management / Interventions<br> == | == Management / Interventions<br> == | ||
Treatment of Achilles tendinopathy is initially non-operative, including rest, equipment changes, strength and flexibility exercises, anti-inflammatory agents and corticosteroids. The effects of physical therapy on Achilles tendonitis is poorly understood, although musculotendinous strengthening appears essential. Eccentric exercises have been shown to have positive effects of Achilles tendonitis, and remains the gold standard for rehabiliation of this condition.<ref name="1" /><ref name="2" /> A study by Roos et al concluded that eccentric exercises improve function and reduce pain and effects were apparent after 6 weeks of treatment, lasting for 1 year. <br> | |||
== Differential Diagnosis<br> == | == Differential Diagnosis<br> == | ||
Posterior ankle impingement, medial tendinopathy, retrocalcaneal bursitis, sural nerve, lumbar radiculopathy, ankle OA, DVT, Haglund deformity, partial Achilles tendon rupture.<br> | |||
== References == | == References == | ||
Revision as of 03:43, 6 December 2009
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Clinically Relevant Anatomy
[edit | edit source]
The Achilles tendon is the single tendon of the soleus and gastrocnemius muscles, inserting into the calcaneus.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Mechanism of Injury / Pathological Process
[edit | edit source]
Achilles tendonitis is commonly seen in athletes who sustain an increase in training load, and is most often due to overuse. Tendons respond poorly to overuse, therefore healing is slow. This can leave a tendon pathologically substantially defective, which decreases tendon strength and leaves it less able to tolerate load, thus vulnerable to further injury.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title Extrinsic factors contributing to this condition include training errors and inappropriate footwear. Intrinsic factors include inflexibility, weakness and malalignment.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Clinical Presentation[edit | edit source]
Morning pain is a hallmark symptom because the Achilles tendon must tolerate full range of movement including stretch immediately on rising in the morning. Symptoms are typically localized to the tendon and immediate surrounding area. Swelling and pain at the attachment are less common. The tendon can appear to have subtle changes in outline, becoming thicker in the A-P and M-L planes.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Diagnostic Procedures[edit | edit source]
Imaging studies are not necessary to diagnose Achilles tendonitis, but may be useful with differential diagnosis. US is the imaging modality of first choice as it provides a clear indication of tendon width, changes of water content within the tendon and collagen integrity, as well as bursal swelling. MRI may be indicated if diagnosis is unclear or symptoms are atypical. MRI may show increased signal within the Achilles.
Outcome Measures[edit | edit source]
Robinson et al recommend the VISA-A scale. This is a subjective rating scae that quantifies the symptoms and dysfunction in the Achilles tendon. It is very useful to rate Achilles tendons and to assess progress of recovery during rehabilitation.
Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title
Management / Interventions
[edit | edit source]
Treatment of Achilles tendinopathy is initially non-operative, including rest, equipment changes, strength and flexibility exercises, anti-inflammatory agents and corticosteroids. The effects of physical therapy on Achilles tendonitis is poorly understood, although musculotendinous strengthening appears essential. Eccentric exercises have been shown to have positive effects of Achilles tendonitis, and remains the gold standard for rehabiliation of this condition.Cite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive titleCite error: Invalid <ref> tag; name cannot be a simple integer. Use a descriptive title A study by Roos et al concluded that eccentric exercises improve function and reduce pain and effects were apparent after 6 weeks of treatment, lasting for 1 year.
Differential Diagnosis
[edit | edit source]
Posterior ankle impingement, medial tendinopathy, retrocalcaneal bursitis, sural nerve, lumbar radiculopathy, ankle OA, DVT, Haglund deformity, partial Achilles tendon rupture.
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
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