Orthopedics Book

http://www.fpnotebook.com/

Achilles TendonitisAka: Achilles Tendinitis, Achilles Peritendinitis, Achilles Tendinopathy

Advertisement

  1. Pathophysiology
    1. Achilles-calf complex responsible for Running push-off
      1. Allows for airborne phase of Running gait
    2. Mechanism of Running Injury
      1. Incorrect Running technique
      2. Poorly fitting shoes
      3. Over-pronation
    3. Rheumatologic Conditions predisposing to Tendonitis
      1. Spondyloarthropathy
      2. Rheumatoid Arthritis
  2. Etiology: Achilles tendon inflammation
    1. Chronic overuse of calf muscle
    2. Common overuse injury
      1. Occurs in 10% of runners
      2. New athletes to sport
      3. Dancing
      4. Gymnasts
      5. Tennis Players
  3. Symptoms
    1. Heel Pain and stiffness at achilles tendon
      1. Worse with strenuous Exercise
      2. Better with walking
    2. Uneven gait may result
  4. Signs
    1. Inflammation at Achilles tendon or its insertion
      1. Pain, local tenderness, and swelling
      2. Gradual onset
    2. Negative Thompson Test (differentiates rupture)
    3. Dry crepitus may be present on palpation
    4. Provocative maneuvers that aggravate pain
      1. Passive Stretching of tendon (ankle dorsiflexion)
      2. Lightly squeezing calf
    5. Associated: Peritendinitis
      1. Tendon sheath inflammation (2-6 cm above insertion)
      2. Pain and burning worse with Exercise
      3. Pain on rubbing tendon suggests Peritendinitis
  5. Differential Diagnosis
    1. See Heel Pain
    2. Achilles Tendon Rupture
  6. Management
    1. Relative rest (may require off sport completely)
    2. Gentle Stretching (avoid worsening injury)
      1. Includes slow warm-up before Exercise
      2. Calf stretches with leg straight and bent
      3. Toe raises
    3. Local Ice Therapy
      1. Ice massage after activity for 20 minutes
    4. Strengthen calf muscles
      1. Gastrocnemius muscle
      2. Soleus muscle
    5. NSAIDs for 10 days at initial symptom onset
    6. Obtain correct Running Shoe (e.g. over-pronators)
    7. Weight loss if over Ideal Weight
    8. Consider physical therapy
      1. Local ultrasound
      2. Flexibility and Strength Training
      3. Assist with correcting biomechanics of sport
    9. Short Leg Walking Cast
    10. Avoid local Corticosteroid Injections
      1. Risk of Achilles Tendon Rupture
  7. Course
    1. May persist for months
    2. Athletes often require 4 weeks out of all sports
      1. Welsh (1980) Can Med Assoc 122:193
  8. References
    1. Liu in Noble (2001) Primary Care, Mosby, p. 1262
    2. Mazzone (2002) Am Fam Physician 65(9):1805

Achilles tendinitis (C0263933)

ConceptsDisease or Syndrome (T047)
EnglishAchilles tendiditis, Achilles tendinitis
Spanishtendinitis aquileana
Parent ConceptsTendinitis (C0039503), Inflammatory disorder of extremity (C1285336), Disorder of lower leg (C1290880)
SourcesMTH, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree