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Achilles Tendinitis Mechanism, Differential diagnosis, Treatment

Achilles Tendinitis Mechanism, Differential diagnosis, Treatment post thumbnail

ACHILLES TENDINITIS

🔰History


■ Mechanism
➣ Overuse, muscle imbalance, poor exercise biomechanics
■ Initial complaints
➣ Pain, swelling, decreased activity tolerance
■ Chronic complaints
➣ Pain with activity, difficulty running and jumping
➣ Swelling
■ Common in runners

🔰Physical exam

ACHILLES TENDINITIS

Acute

➣ Diffuse swelling, pain with palpation, pain with dorsiflexion
➣ Lateral pain – Associated with supination
➣ Medial pain – Associated with pronation

Chronic

➣ Pain, decreased dorsiflexion, atrophy
➣ Longitudinal swelling rather than well localized
■ Classification
➣ Insertional vs. non insertional studies

Radiographs

➣ AP, lateral, mortise views (lateral most important)
➣ Radiographs generally normal
➣ Calcifications, traction spurs – Degenerative changes, degenerative changes or partial tear

MRI

➣ Tendinitis – Peritendinous fluid/edema, no tendinous signal
changes
➣ Differential diagnosis using MRI
■ Tendinosis (intrasubstance signal changes)
■ Partial tear
■ Retrocalcaneal bursitis

🔰Differential diagnosis

■ Achilles tendinosis
■ Partial tear
■ Haglund’s deformity
■ Retrocalcaneal bursitis

🔰Treatment

■ Nonoperative
➣ Types of nonoperative treatment
➧ Immobilization (cast, walking boot)
➧ Heel lift
➧ Anti-inflammatory medications
➧ Achilles stretching
➧ Physical therapy (including ice massage)
➧ Steroids contraindicated due to risk of rupture


Operative
➣ Debridement if refractory to conservative measures
➣ Lysis of adhesions


Disposition
N/A

🔰Prognosis

■ Pure tendinitis without associated tendinosis usually responds well to conservative measures.
■ Surgical results for insertional Achilles tendinitis are worse than those for non insertional Achilles tendinitis.

■ Long-term complications

➣ Tendon ruptures after steroids by mouth or injection
➣ Chronic swelling or pain can result even after debridement

Sports MCQs

HomeSports GK

Sports and Games Related general knowledge questions #2 MPT preparation Quiz (physiofitnessdesk.blogspot.com)

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Dr .Lalit Choudhary
Hii everyone, I'm Dr Lalit Choudhary PT. Born and brought up in delhi. Practicing as a professional PHYSIOTHERAPIST. As a therapist I love to interact with others and and get myself updated regarding all the social issues which are leading my countrymen to distress themselves. Yes, I agree that Iam a workaholic but my work gives me immense pleasure but there are sometimes when I feel stressed up so to relax myself I travel to new places, meet new people and try to adopt their culture. Most of the time I like to travel hills as it helps me to relax and enjoy our nature beauty. For being a good therapist and to deal with all the difficulties I always prefer to be good listener and have good patience that is what my strength is. I also work as a social worker and the Founder of thesocialphysiofitnessclub and PHYSIO FIT INDIA. In last I just want to say that " I believe that physical therapy is not just a therapy but actually a remedy which not only make you physically fit but also adds happiness, joy and more days to your life." So don't just sit and thought now it's time to stand and work on yourself.

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