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Achilles tendinopathy/ achilles rupture
Terms in this set (41)
Achilles tendon is made up of what two muscles?
gastroc. and soleus
Where does the achilles tendon insert?
What is the achilles tendon sheathed in?
Is the achilles tendon vascularized?
•Inflammation/thickening of peritendon sheath surrounding AT
•Degeneration of tendon without inflammation
the gastroc portion of achilles tendon inserts where?
posterolaterally on calcaneus
the soleus portion of the AT inserts where?
anteromedially on calcanues
where is the zone of hypovascularity for the AT
2-7cm proximal to the tendon insertion
describe properties of a healthy tendon
•Healthy tendons are brilliant white in color with a fibroelastic texture
Intrinsic factors of Achilles tendinopathy
Extrinsic factors of Achilles tendinopathy
•Changes in training
•Poor running technique
•Footwear and training on hard surfaces
In the early stages of AT what occurs?
pain with prolonged running, jumping, and activity
•As progresses pain occurs also at rest
s/s of non-insertional AT
•Tenderness to palpation and swelling in region proximal to insertion onto calcaneus
•Fusiform thickening and swelling of tendon
->6mm tendon thickness is part of diagnostic criteria
s/s of insertional AT
•Tenderness to palpation and swelling at ridge where aT inserts onto calcaneus
-thickening and swelling of tendon
what is the progression of muscle injury?
t/f: Overuse tendinopathy does not follow the same path as muscle injury?
T; Results in long-term disruption of extracellular matrix
T/F: tendon injury may not have an inflammatory phase and can result in a permanent stage of pathology?
T; called failed healing
4 changes that happen with Tendinopathy
•Activation and increased number of cells
•Causes increase in ground substance and collagen
•These cells produce an abundance of Type III collagen
•Thinner - less capable in forming bundles
•Combination of inferior collagen and increased ground substance results in less ability to tolerate force
What injury induces achilles tendinopathy?
•In jumping activities Achilles and Patellar tendon subjected to forces ranging from 6-14x BW
what are some pt history points to notice?
•Change in activity
when would patients with AT have pain?
•Pain with stretching
•Pain under load
•Painful with jumping activities
•Running and hopping
•Pain at beginning during initial stages
•Morning discomfort "stiffness"
Whats a test that can be done to test the Achilles tendon's endurance?
Heel raise endurance test
What is the traditional rehab for someone with achilles tendinopathy?
-rest w/ decreased activity/intensity
, full ROM DF/PF eccentrics
-ASTYM-soft tissue mobilizaiton
What is a contraindication with pain in the achilles tendinopathy pts? what do you do to resolve it?
•Pain that lasts longer than 24 hours contraindicated
-document and back down therapy
-apophysitis at the insertion of the Achilles tendon
What population is Sever's disease seen in?
•Boys 10-12; Girls 8-10
What can you do to treat Sever's disease?
•Stop all Physical activity for up to 2 weeks
•Work on flexibility
Achilles tendon rupture MOI
-a sudden explosive plantar flexion force while a foot is dorsiflexing eccentrically
-will hear an audible "pop" usually
population achilles tendon ruptures are common in
-Most common in men between the ages of 35 and 55
-Out of shape -"weekend warrior" athletes
What are some causes of achilles tendon rupture?
s/s of achilles tendon rupture
◦Hear a loud pop
◦Feeling as though they had been struck from behind
◦Inability to walk normally
◦Calf swollen secondary to hemorrhage
◦Loss of tendon continuity
Where in the tendon does it usually rupture?
-generally occurs 2-6 cm proximal to Achilles tendon insertion
-Thought to be area of poor blood supply
What is the Thompson sign?
Pt laying in prone If you squeeze the calf and the foot does not PF (+) Thompson sign
-(+) in achilles ruptures
Conservative treatment for achilles rupture
-Short leg brace with foot held in equinus (PF) for 8 weeks
-Best for sedentary people
-Seldom used for physically active
-Risk of re-rupture >
-Tensile strength 30% of norm
What is the other option for treatment for physically active individuals?
the pt after surgery for rupture should be NWB for how long?
-may not even begin therapy for 4-8 wks
treatment for post-op achilles rupture pts maximum protection phase (0-4 wks)
◦Active DF/PF, Inversion/Eversion, toe curls
◦Maintain Total Leg Strength (TLS)
◦Repair site mobilization
-gentle isometrics in all directions
treatment for post-op achilles rupture pts moderate protection phase (4-8wks)
-PWB, with use of heel lift
◦ROM of ankle: Joint mobilizations, AROM, gentle PROM of ankle, OKC stretching of gastroc/soleus
◦Intrinsic foot exercises
◦Seated - NWB BAPS
◦OKC isometrics and sub-maximal isotonics with cuff weights, manual resistance or tubing
◦Bicycling or walking in a pool, unloaded
-no IN/EV stretching
treatment for post-op achilles rupture pts late moderate protection phase (8-12wks)
WBAT or FWB w/ heel lift
◦Improve balance, stability and CKC LE control by proprioceptive exercise progression
◦Unilateral balance exercises
◦Begin partial squatting activities
◦Begin FWB self stretching, no incline progressing to with incline or wedge board
treatment for post-op achilles rupture pts advanced phase (12+wks)
-Toe raises to 1.5 times BW
-Begin jogging on mini-tramp
-Figure 8 running and cutting when patient can perform 20 min of aerobic activity
-Straight running at 12 weeks (3 months)
-Cutting exercises at 4 months (4 months)
-Most patients return to full activity by 9 months postoperatively
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