Achilles Tendinitis Melissa LeBlanc

Introduction to Achilles Tendinitis Achilles Tendinitis is an overuse injury identified by an inflammation of the Achilles Tendon. It is most often caused by a change in footwear, playing surface or level of intensity of physical activity (Hargrove, MBBS, FRCS & McClean, MBBS, MRCS, AFRCS, 31). It can also be associated with the use of some antibiotics and medications. The causes of this pathology are multi faceted and not understood completely (Saglimbeni, MD, Fulmer, DO & , 2012).

http://www.miamisportsmedicine.com/AchillesTendonInjury.html

There is some indecision on the naming and classification of this injury. Some suggest that tendinopathy or tendinosis is a more appropriate terminology for this injury because the inflammation suggested by the current terminology is not present (Hargrove, MBBS, FRCS & McClean, MBBS, MRCS, AFRCS, 31). Incidence of Achilles Tendinitis Observed most commonly in athletes who participate in sports requiring repetitive jumping or sprinting such as gymnastics, basketball, cycling, running and volleyball.

Achilles tendonitis seen in jumpers correlates to risk factors of increased intensity, participation in a new activity, or new or unsuitable footwear (Hargrove, MBBS, FRCS & McClean, MBBS, MRCS, AFRCS, 31). Hyperpronation may also contribute to development of this pathology. Low saddle height in cyclists, results in increased dorsiflexion of the ankle while pedaling, may also be a causative factor (Hargrove, MBBS, FRCS & McClean, MBBS, MRCS, AFRCS, 31). Achilles Tendinitis is known to effect 7-18% of club runners and seem to be more common in older athletes and men (Saglimbeni, MD, Fulmer, DO & , 2012). Etiology of Achilles Tendinitis Achilles Tendinitis can be acute or chronic. It can be caused by many factors such as wearing high heels, not stretching between exercise sessions, increasing the level of activity too quickly, and other foot problems, such as overpronation or flat feet ("Achilles tendon injury"). Achilles Tendinitis has also been attributed to the use of certain antibiotics such as fluoroquinolones and ciproflacin. As well as steroid medications (Hargrove, MBBS, FRCS & McClean, MBBS, MRCS, AFRCS, 31). Anatomy and Physiology Anatomy In this pathology the Achilles tendon is irritated and inflamed. The Achilles tendon is the bodys largest tendon and connects the gastrocnemius-soleus to the calcaneus bone in the foot. The most commonly effected portion of the tendon is approximately 2-5 cm above the calcaneus. This point is the thinnest portion of the tendon and is the most vulnerable to exertion forces. Achilles_tendinitis_video_3 http://www.youtube.com/watch?v=1mfWbHSaE6E Physiology There are a number of factors that have been attributed to tendinopathies, including Achilles tendinitis. As previously stated age and certain medications can cause Achilles tendonitis. Other factors that are associated risk factors of Achilles tendonitis are: chronic kidney failure, systemic lupus erythematosus (SLE), Rhematoid arthritis (RA), type O blood, diabetes mellitus, collagen deficiencies, thyroid and parathyroid disorders, and infectious diseases (Saglimbeni, MD, Fulmer, DO & , 2012). Evaluation of Achilles Tendonitis Signs and Symptoms Stiffness, tenderness, mild aching or pain in the back of the heel, exacerbated upon exertion. Pain may be worse in the mornings and decreases with mild activity such as walking (Mayo Clinic Staff, 2012) and ("Achilles tendon injury). Special tests and Evaluation Visual evaluation of the posterior aspect of the lower leg that includes palpation and ROM in the lateral/medial as well as extension/dorsiflexion aspects. The tendon may have palpable nodules or a wet leather feel (Hargrove, MBBS, FRCS & McClean,

MBBS, MRCS, AFRCS, 31) as well as pain upon palpation. X-rays and MRIs are also a valuable assessment tool for Achilles tendinitis. Achilles_tendinitis_video_1 http://www.youtube.com/watch?v=dwwwCsOGDpU Differential Diagnoses Differential diagnoses of Achilles Tendinitis include: Ruptured Bakers Cyst, Retrocalcaneal Bursitis, Partial Achilles Tendon Rupture, Hagland Deformity, Gastrocnemius-Soleus muscle strain/rupture, Deep Vein Thrombosis, and Ankle osteoarthritis. Prognosis and Recent Evidence Informing Best Clinical Care The prognosis of tis injury is very good as long as the patient stretches and is in conservative in their approach to exercise. For acute injuries the best care indicates that NSAID therapy with stretching and strengthening is the most effective for healing and decreasing reoccurrence. Rest and ice in conjunction with the aforementioned treatment has shown to be effective in full recovery for those diagnosed with Achilles tendinitis. For chronic conditions surgery is an option but a slow healing time makes this the last resort treatment option. The use of steroid therapy is a controversial option for the treatment of Achilles tendinitis (Saglimbeni, MD, Fulmer, DO & , 2012). Achilles_tendinitis_video_2 http://www.youtube.com/watch?v=gS1txxyvVNo

REFERENCES: Achilles tendon injury. (n.d.). Retrieved from http://www.webmd.com/fitnessexercise/guide/achilles-tendon-injury Hargrove, MBBS, FRCS, R., & McClean, MBBS, MRCS, AFRCS, C. (31, AUG 31). Achilles tendon pathology. Retrieved from http://emedicine.medscape.com/article/1235456-overview Mayo Clinic Staff. (2012, Oct 02). Achilles tendinitis . Retrieved from http://www.mayoclinic.com/health/achilles-tendinitis/DS00737/DSECTION=symptoms Saglimbeni, MD, A. J., Fulmer, DO , C. J., & (2012, Jan 18). Achilles tendon injuries and tendonitis . Retrieved from http://emedicine.medscape.com/article/309393-treatment