achilles tendonitis and rupture
DESCRIPTION
ACHILLES TENDONITIS AND RUPTURE. Dr Carl Clinton (no conflict of interests). Will not include such pathologies:- a) Retrocalcanel Bursitis b) Haglund’s Deformity c)Impingement Syndrome e)‘Pump Bump’ e)Ankle O/A f)Ruptured Bakers’s Cyst g)DVT. ANATOMY 1. - PowerPoint PPT PresentationTRANSCRIPT
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ACHILLES TENDONITISAND RUPTURE
Dr Carl Clinton(no conflict of interests)
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Will not include such pathologies:-a) Retrocalcanel Bursitisb) Haglund’s Deformityc) Impingement Syndromee) ‘Pump Bump’e) Ankle O/Af) Ruptured Bakers’s Cystg) DVT
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a) Attaches the plantaris/ gastrocnemius and soleus muscles to the calcaneusb) Thickest and strongest tendon in the bodyc) Achilles muscle reflex tests the integrity of the S1 spinal rootd) About 15cm (6in) long
ANATOMY 1
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e) The tendon can receive a load stress 3.9 times body weight during walking and7.7 times body weight during running
f) The tendon is surrounded by a connective tissue sheath (paratenon) rather than a true synovial sheath
ANATOMY 2
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g) Arterial anatomy of Achilles - supplied by two arteries - the posterior tibial
- the peroneal arteries - 3 vascular territories - the midsection supplied by the peroneal artery - promixal and distal section supplied by the posterior tibial arteryThe midsection of Achilles markedly more hypovascular (risk rupture and surgical complications at its midsection).
ANATOMY 3
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a) OVERUSE - too long/too fast/too steep/ too explosiveb) MISALIGNMENT - gait (excessive pronation)c) IMPROPER FOOTWEAR - saddle too low/extra dorsiflexione) MEDICAL SIDE EFFECTS - quinolone group of A/B (ciprofloxacin)e) CORTISONE- indirect - weakened Achilles feels too comfortableg) ACCIDENTS - laceration/crushh) GENETICS - individuals with the single nuclear plymorphism (SNP) TT genotype of the GDF5rs 143383 variant have twice the risk of developing Achilles problemsi) SYSTEMIC CONDITIONS - gout/RA/SLE/Cushing’s syndrome
EPIDEMIOLOGY AND CAUSES
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a) ACHILLES TENDONITIS- gradual onset pain/stiffness - improves with heat and exercise ‘able
to run off symptoms’- may with strenuous activity get worse
or experience calf pain- tenderness of the tendon on palpation- there may be crepitus and swelling- may be pain on active movement of the
ankle joint
PRESENTATION
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b) ACHILLES RUPTURE- rupture can occur at any age but most
common 30 - 50 year old
- acute onset of pain in tendon- sudden ‘sharp pain’- snap ‘heard’
- may have PMH of Achilles Tendonitis- inability to stand on tiptoe- altered gait ‘inability to push off’- swelling/ GAP
PRESENTATION
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- observe gait- look for swelling/bruising- may have a palpable GAP- active plantar flexion is weak or absent- ‘Thompson’s Test’ ‘calf squeeze test’- fusiform swelling with pain to palpation- gout/RA/SLE/Cushings’ Syndrome/DVT/ ruptured Bakers’s Cyst/O/A ankle (examine ankle/knee/calf)
EXAMINATION
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INVESTIGATIONS
- UTRASOUND- MRI
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ACHILLES TENDONITISInsufficient evidence from randomised controlled trials to determine which method of treatment is the most appropriate.
MANAGEMENT
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a) abstain from aggravating activitiesb) NICER - ?? Use NSAID (inflammation v degenerate)c) physio + relative rest (alternative exercise)
Podiatrist- ‘stretching/strengthening’
Hip/back muscles tightCalf muscles tightStrengthening anterior tibialis- massage- eccentric exercises- orthotics (gait) / review footwear
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d) physical therapy - US/electric stimulation/laser photo stimulation
e) other treatments- heparin- steriod injections/sclerosant injections- glycosaminoglycan sulfate- actovegin- GTN patches- electronic wave shock treatment- extra corporeal shockwave therapy- blood letting/blood injections- needling- casting
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f) surgery -? last resort- ? after six months- ? plantaris wrap around- ? foot in equinus in plaster 6/52- ? degenerate v inflammatory
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MANAGEMENT
ACHILLES RUPTURESURGICAL V CONSERVATIVE
a) surgery v non surgery‘NO CONSENSUS’ :- b) best surgical approach
c) best non-surgical approach
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Surgical treatment of Acute Achilles Rupture significantly reduces the risk of re-rupture compared with non-surgical treatment, but produces significantly higher risks of other complications such as infection, adhesions and disturbed skin sensibility/breakdown.
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PROGNOSIS
ACHILLES TENDONITIS
a) no consensus on best treatmentb) recovery can take weeks or monthsc) surgery is possible
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PROGNOSIS
ACHILLES RUPTURE
a) no consensus on best treatmentb) surgical treatment decreased
risk of re- rupturec) may take 1 year to recoverd) may be left with slight loss of
functione) usually good prognosis however
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POSSIBLE EXPLANATION:-
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ANY QUESTIONS ?
July 2013