Achilles Tendon Injuries

Structure and Function:ankle

 

  • Two muscles in calf joint (gastrocnemius and soleus; gastro goes across two joints – knee and ankle)
  • Ankle-plantar function
  • Elastic structure
  • Key function: absorbs force and recoils

Pathology

  • Rupture
    • Acute injury
    • Possible pre-existing pathology
    • History – feels like somebody kicked them
    • Examination
    • Investigation – if examined immediately then can feel the tear, but then blood clot will fill it.
    • Treatment
      • Surgical – mixed results for stitching
      • Conservative
    • Rehab
      • Pathology/procedure
      • Degree of atrophy
      • Commitment to rehab
      • Very hard to get back to the same standard after achilles tendon damage
    • Tendonopathy
      • Also known as tendonitis but this is false as it suggests inflammation, but anti-inflammatory tablets will do nothing.
      • Pathology
        • Pathology is a continuum
        • Reactive tendinopathy
        • Tendon disrepair
        • Tendon degeneration
      • Symptoms
      • Investigation
      • Underlying causes
      • Role of Pain
        • Occurs at any point – normal looking ones can hurt
        • 2/3rds of ruptures have no pain

Treatment:

  • With so many treatments available, none can be gold standard
Unloading Eccentric loading Strengthening NSAIDs
Massage Surgery Orthotics GTN patches
Acupuncture ESWT Dry needling Various injections
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