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| '''Original Editor '''- Richard Benes | | '''Original Editor '''- [[User:User Name|User Name]] |
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| '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} ; | | '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} |
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| == Anatomy == | | == Description == |
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| The Achilles (calcaneal) tendon is a common tendon shared between the [[Gastrocnemius|gastrocnemius]] and [[Soleus|soleus]] muscles of the posterior leg. It connects the two muscle groups (collectively, triceps surae) to the calcaneus bone. Generally, the tendon winds 90 degrees on its path towards the heel, such that the gastrocnemius attaches laterally and the soleus attaches medially.<ref name="Moore">Moore KL, Agur AMR, Dalley AF. Essential clinical anatomy. 4th ed. Baltimore: Lippincott Williams &amp;amp; Wilkins, 2011.</ref><br>
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| A subcutaneous calcaneal bursa permits movement of the skin over the flexed tendon. A deep bursa of the Achilles tendon reduces friction to allow free movement of the tendon over the bone.<ref name="Moore" />
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| === Attachments === | | === Attachments === |
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| The tendon provides a distal attachment site for the gastrocnemius (lateral and medial heads) as well as the soleus muscles. It inserts onto the posterior surface of the calcaneus (heel bone). The plantaris tendon also fuses with the medial side of the Achilles tendon proximal to its attachment site.<ref name="Drake">Drake RL, Vogl AW, Mitchell AWM. Gray's anatomy for students. 2nd ed. Philadelphia: Churchill Livingstone Elsevier, 2010.</ref>
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| == Function == | | == Function == |
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| Through the action of the triceps surae, which raises the heel and lowers the forefoot, the Achilles tendon is involved in plantarflexion of the foot (approximately 93% of the plantarflexion force).<ref name="Moore" /> The anatomy of the tendon provides for both elasticity (recoil) and shock-absorbance in the foot.<ref name="Moore" /> It is the largest and strongest tendon in the human body and is capable of supporting tensional forces produced by movement of the lower limb.<ref name="Järvinen">Järvinen TA, Kannus P, Józsa L, Paavola M, Järvinen TL, Järvinen M. Achilles tendon injuries. Curr Opin Rheumatol 2001;13:150-5. http://journals.lww.com/co-rheumatology/pages/articleviewer.aspx?year=2001&amp;amp;issue=03000&amp;amp;article=00009&amp;amp;type=abstract (accessed 15 Mar 2015).</ref><br>
| | == Clinical Relevance == |
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| == Pathology/Injury ==
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| The Achilles tendon is susceptible to damage with repetitive use or overload. These types of injuries typically occur in athletes and are usually sports- or exercise-related.<ref name="Järvinen" />
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| The most common types of injuries are due to overuse and Achilles tendon disorders, of which 55%-65% are diagnosed as [[Achilles Tendinopathy|Achilles tendinopathy]]. Insertional issues ([[Retrocalcaneal Bursitis|retrocalcaneal bursitis]] and insertional tendinopathy) account for 25%-35% of cases, with the remaining diagnoses as partial tears or undiagnosed complete ruptures.<ref name="Järvinen" />
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| [[Achilles Rupture|Complete rupture]] of the Achilles tendon has been estimated to occur at a rate of 5.5 to 9.9 per 100,000 in North America and between 6 to 18 per 100,000 in Europe.<ref name="AAOS">American Academy of Orthopaedic Surgeons. The Diagnosis and Treatment of Acute Achilles Tendon Rupture. Rosemont: American Academy of Orthopaedic Surgeons, 2009. Available at: http://www.aaos.org/Research/guidelines/atrguideline.asp</ref> Roughly 60-75% of ruptures take place in sporting activities, including basketball and soccer.<ref name="Järvinen" />
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| == Physiotherapeutic techniques ==
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| === Palpation ===
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| The foot is plantarflexed against resistance or gravity (body weight) while observing the posterior leg.
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| === Examination<br> === | | == Assessment == |
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| '''Achilles Tendinopathy'''<br>
| | == Treatment == |
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| The [[VISA-A scale|VISA-A]] is a self-administered questionnaire that evaluates symptoms and their effect on physical activity for patients with chronic Achilles tendinopathy.<br>
| | == Resources == |
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| '''Achilles Rupture'''<br>
| | == References == |
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| The [[Matles Test|Matles Test]] is a visual diagnostic test for suspected Achilles tendon rupture.<br>
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| The [[Thompson Test|Thompson Test]] is used to identify the presence of a complete Achilles rupture and is performed by squeezing the calf.<br>
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| === Treatment techniques ===
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| '''Achilles Tendinopathy'''<br>
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| A summary of treatment interventions can be found in the [[Achilles Tendinopathy Toolkit: Summary of Interventions|Achilles Tendinopathy Toolkit]].<br>
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| '''Achilles Rupture'''<br>
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| Optimal treatment of acute Achilles rupture is a highly contested topic<ref name="Pedowitz">Pedowitz D, Kirwan G. Achilles tendon ruptures. Current Reviews in Musculoskeletal Medicine 2013;6(4):285-293. http://link.springer.com/article/10.1007%2Fs12178-013-9185-8 (accessed 15 Mar 2015).</ref>, but can be broken down into: open operative, percutaneous operative, and nonoperative types.<ref name="Järvinen" /><br>
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| More recently, evidence-based guidelines for managing Achilles tendon rupture have been released by the American Academy of Orthopaedic Surgeons (AAOS). None of the recommendations have a grading of "strong", but consensus recommendations based on expert opinion advocate the need for a detailed patient history and physical examination in diagnosis.<ref name="AAOS" /><ref name="Pedowitz" /> The group also recommends a more cautious approach in operative treatment for certain patients, including those with diabetes and/or neuropathy, aged 65 or older, who are obese or who have sedentary lifestyles, who are immunocompromized, and who use tobacco.<ref name="AAOS" /> The only recommendations rated as "moderate" in strength (fair quality evidence) were specifically for '''<u>post-operative interventions</u>'''. These were the suggestions for (1) protective weight bearing and (2) use of a protective device that allows mobilization 2-4 weeks post-operatively.<ref name="Pedowitz" /><ref name="AAOS" /> <br>
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| A review on the topic advocates for educating patients on the potential risks and benefits of each type of treatment, including operative and nonoperative types.<ref name="Pedowitz" /><br>
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) ==
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| <div class="researchbox">
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| <rss>Feed goes here!!|charset=UTF-8|short|max=10</rss><br>
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| == Resources ==
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| [[A review of the literature to evaluate the efficacy of conservative eccentric exercise for achilles tendinopathy|A review of the literature to evaluate the efficacy of conservative eccentric exercise for Achilles tendinopathy.]]
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| [http://www.aaos.org/Research/guidelines/atrguideline.pdf AAOS Guideline and Evidence Report: The Diagnosis and Treatment of Acute Achilles Tendon Rupture] (2009)<br>
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| </div> | |
| == References ==
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| <references /><br>
| | [[Category:Anatomy]] [[Category:Ligaments]] |
