Achilles Tendinosis and Tendinitis

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Questions and Answers

What is the typical age range of individuals affected by Achilles Tendinopathy?

70-90 years old

50-70 years old

20-30 years old

30-50 years old (correct)

What is the degree of dorsiflexion range of motion that increases the risk of Achilles Tendinopathy?

13 degrees

11.5 degrees (correct)

10 degrees

12 degrees

What is the location of symptoms in Achilles Tendinopathy?

At the middle of the tendon

At the insertion of the tendon

2-6 CM proximal to the insertion (correct)

At the end of the tendon

What is the result of a positive Royal London Hospital Test?

Tenderness at 3 CM proximal to the calcaneus with ankle in plantar flexion Signup and view all the answers

What is the typical treatment for Achilles Tendinopathy?

Eccentric strengthening every other day Signup and view all the answers

What is the primary risk factor for Achilles Tendinopathy?

Abnormal DF range of motion Signup and view all the answers

What is the recommended timing for starting eccentric strengthening in patients with Achilles tendinopathy?

After 2 weeks of decreasing symptoms Signup and view all the answers

What is the typical progression of eccentric strengthening in patients with Achilles tendinopathy?

From seated position to single limb eccentric Signup and view all the answers

What is a characteristic of insertional Achilles tendinopathy?

All of the above Signup and view all the answers

What is the recommended approach to loading the tendon in patients with Achilles tendinopathy?

Load the tendon appropriately based on the patient's tolerance Signup and view all the answers

What is the typical outcome for patients with insertional Achilles tendinopathy who undergo eccentric lowering programs?

Poor outcome Signup and view all the answers

What is the recommended timeline for resuming recreational activities after Achilles repair surgery?

6-12 months Signup and view all the answers

What is the primary goal of the slow training protocol in patients with Achilles tendinopathy?

To allow the tendon to adapt to the load progressively Signup and view all the answers

What is the significance of the order of exercises, 'Isometrics > Concentrics > Eccentrics', in patients with Achilles tendinopathy?

It represents the order of exercises in terms of their load on the tendon Signup and view all the answers

What is the rationale for not isolating the tendon eccentrically in patients with Achilles tendinopathy?

To load the tendon appropriately and progress the patient over time Signup and view all the answers

What is the significance of the 'boot' in the treatment of Achilles tendon rupture or tear?

It is a device used to immobilize the foot for 4 weeks Signup and view all the answers

What is the typical progression of weight bearing after removal of the boot in patients with Achilles tendon rupture or tear?

Progressive weight bearing after boot removal, with full weight bearing at 12 weeks Signup and view all the answers

What is the significance of the 6-12 month timeline in patients with Achilles tendon rupture or tear who undergo surgery?

It is the time required for the patient to resume recreational activities Signup and view all the answers

What is the main reason why the Achilles tendon is prone to injury?

The tendon is subjected to continuous concentric and eccentric loading Signup and view all the answers

What is the typical presentation of Achilles Rupture?

Sharp pain, audible pop, and inability to plantarflex the foot Signup and view all the answers

What is the difference between Achilles Tendinosis and Achilles Tendinitis?

Tendinosis is chronic, while Tendinitis is acute Signup and view all the answers

What is the purpose of the Royal London Hospital Test?

To test for tenderness at 3 CM proximal to the calcaneus Signup and view all the answers

What is the significance of 11.5 degrees of dorsiflexion range of motion?

It is the range of motion that increases the risk of Achilles Tendinopathy Signup and view all the answers

What is the difference between a Gastroc/Soleus Strain and an Achilles Rupture?

A Gastroc/Soleus Strain is typically felt higher up in the calf region, while an Achilles Rupture is felt in the ankle region Signup and view all the answers

Study Notes

Achilles Tendinosis/Tendinitis

Acute or chronic condition of the Achilles tendon
Chronic degenerative changes in the tendon
Acute inflammation in the peritendon
Can be insertional or non-insertional
Poor blood supply in the Achilles tendon 2-6 CM from the insertion
Most common in athletic activities: running, dance, ballet, and soccer

Achilles Tendinopathy

Most often affects recreational athletes
In runners, incidence ranges from 7-9%
Typically affects age 30-50-year-olds
Males are most affected
Dense connective tissue with poor blood supply
Can be inflammation of the paratenon
Often tendinosis – fatty infiltrate in the tendon

Risk Factors

Abnormal DF range of motion (11.5 degrees of DF with knee extended increases risk 3.5 times)
Abnormal subtalar joint motion (inversion excessive 32.5 increases risk 2.8 times)
Decrease of total inversion/eversion range (less than 25 degrees)
Decreased plantarflexion strength
Increased pronation

Diagnosis

Symptoms located at 2-6 CM proximal to insertion
Decreased PF strength
Royal London Hospital Test: tenderness at 3 CM proximal to calcaneus with ankle in plantar flexion
Painful ARC

Prognosis

Good in 4-6 months with therapy

Achilles Rupture

Complete rupture occurs usually in middle-aged individuals
Examples: Kobe Bryant and Kevin Durant
Sharp pain, audible pop
Unable to plantarflex the foot
Can be very painful

Gastroc/Soleus Strain

Usually affects middle-aged older adults
Incomplete tear
Pain is felt higher up in the calf region
Tenderness, pain with dorsiflexion

Treatment

Eccentric strengthening: every other day, 3 sets, 12 reps, leg straight, leg bent
Progress weight in backpack
Correct for foot pronation with orthotics or with exercise
Normalize DF ROM
Begin eccentric strengthening after 2 weeks of decreasing symptoms
Slow training protocol – running/intervals, etc.

Insertional Achilles Tendinopathy

Less active people
Associated with retrocalcaneal bursitis, bony spurs, and Haglund Deformity
Tend to have thickening of the tendon
May not respond to eccentric lowering program
Don't lower beyond the floor
Typically poorer outcome
Do not just isolate the tendon eccentrically
Load the tendon appropriately, what the patient can tolerate, and progress the patient over time

Achilles Tendon Rupture/Tear

Some evidence it can be treated conservatively, but not frequently seen
Boot for 4 weeks
Foot placed in plantar flexion
Progressive weight bearing after boot removal with full weight bearing around 12 weeks
Achilles repair surgery is slow progression:
- 6 weeks: bilateral heel raises
- 3 months: unilateral heel raises
- 6-12 months: resume recreational activities
Typically seen in males 40-60 playing athletics

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Description

Test your knowledge on Achilles Tendinosis and Tendinitis, a chronic or acute condition affecting the Achilles tendon. Learn about the causes, symptoms, and types of this condition commonly seen in athletes involved in running, dance, and soccer.