DOCSLIB.ORG

Achilles Tendon Injuries EXPERT CONSULTANT: Michael S

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Achilles Tendon Injuries EXPERT CONSULTANT: Michael S SPORTS TIP Achilles Tendon Injuries EXPERT CONSULTANT: Michael S. George, MD The Achilles tendon is one of the largest, can mask symptoms and lead to greater While partial tears are typically treated thickest, strongest tendons in the human injury as the athlete tries to play through non-operatively, complete Achilles body. It connects the calf muscles to the the pain. tears may be treated both with surgical heel bone, and allows the heel to push off repair and without surgery. While most the ground during movement. Problems Achilles Tendon Ruptures competitive athletes typically undergo affecting the Achilles tendon vary from The Achilles tendon is one of the most surgical repair of the torn Achilles, some mild inflammation and tendinopathy, commonly ruptured tendons in the human recent research studies have shown to partial tears, to complete ruptures. body. The tendon can rupture as the that outcomes may be similar in the athlete is coming down from a jump, general population between tears treated Achilles Tendinopathy and also during a start-and-stop motion operatively and non-operatively. Therefore, Tendinopathy (otherwise known as of many sports. the decision as to whether surgical or non-surgical treatment is chosen should tendinitis or tendinosis) typically results In cases of a complete rupture, a sudden be made by the patient and the treating from repetitive microtrauma and tendon pop or snap is typically felt in the back physician, and should include careful overuse, such as may occur with sports of the ankle, sometimes “as if someone consideration of such factors as the and exercise, and manifests as tendon kicked the leg,” while running, jumping, patient’s age, activity level, and other degeneration and inflammation of the or quickly changing directions. Almost medical issues. surrounding tissues. The most common always the injured athlete is unable to activities that lead to Achilles tendon continue playing or exercising. On-the- Rehabilitation after Achilles repair or overuse include running (especially hills) field medical attention should include during non-surgical treatment involves and jumping. Certain athlete-specific pulling the injured player out of the game, protecting the healing tendon with either factors may predispose to Achilles and eliminating weight-bearing activity a cast or a brace for a period of 6 to 8 tendinopathy, including congenital foot on the injured leg (i.e., putting the weeks, followed by a rehabilitation deformity (for example, an abnormally athlete on crutches). program to gradually regain motion, high arch), excessive weight, muscle strength, and function. Return to athletic Suspected Achilles ruptures should weakness, and lack of flexibility. activities typically occurs after 6 months. be evaluated by a doctor as soon as Typical symptoms of Achilles tendinopathy possible, since delays in diagnosis and Reference include pain, weakness, and limited treatment have been shown to lead to Saltzman CL, Tearse DS. Achilles Tendon Injuries. motion. Treatment must begin with worse outcomes and function. Initial J Am Acad Orthop Surg. 1998;6:316-325. eliminating or decreasing the offending medical evaluation will include a careful activity, and altering the pre-disposing physical examination, and typically X-rays factors, if possible. A guided physical to make sure that there are no fractures therapy program is often instituted or other bone injuries. However, Achilles and is aimed at reducing inflammation, tears cannot be seen on X-rays, and if the improving flexibility and strength, and diagnosis is not obvious from the physical gradually returning the athlete to their examination, an ultrasound or an activity. Anti-inflammatory medications MRI may be ordered. These imaging can be used to help control the pain procedures may also help distinguish associated with inflammation, but between a partial and a complete tear, should be used with caution, as these and determine how significant a tear is. Sports Tips are brought to you by the American Orthopaedic Society for Sports Medicine. They provide general information only and are not a substitute for your own good judgement or consultation with a physician. To order multiple copies of this fact sheet or learn more about other orthopaedic sports medicine topics, visit sportsmed.org. Copyright © 2013. American Orthopaedic Society for Sports Medicine. All rights reserved. Multiple copy reproduction prohibited..
Load more

Recommended publications
  • Physio Med Self Help for Achilles Tendinopathy
    Physio Med Self Help 0113 229 1300 for Achilles Tendinopathy Achilles tendon injuries are common, often evident in middle aged runners to non-sporting individuals. They are often characterised by pain in the tendon, usually at the beginning and end of exercise, pain and stiffness first thing in the morning or after sitting for long periods. There is much that can be done to both speed up the healing and prevent re-occurrence. Anatomy of the Area The muscles of your calf (the gastrocnemius and soleus) are the muscles which create the force needed to push your foot off the floor when walking, running and jumping, or stand up on your toes. The Achilles tendon is the fibrous band that connects these muscles to your heel. You may recognise the term ‘Achilles Tendonitis’ which was the previous name used for Achilles Tendinopathy. However the name has changed as it is no longer thought to be a totally inflammatory condition, but rather an overuse injury causing pain, some localised inflammation and degeneration of the thick Achilles tendon at the back of the ankle. Potential causes of Achilles Tendinopathy and advice on how to prevent it • Poor footwear or sudden change in training surface e.g. sand makes the calf work harder » Wear suitable shoes for the activity (type, fit and condition of footwear). » Take account of the surface you are exercising on and if soft and unstructured like sand or loose soil reduce the intensity / duration or take a short break or reduce any load you are carrying into smaller loads until you become conditioned to it.
    [Show full text]
  • Tibialis Posterior Tendon Transfer Corrects the Foot Drop Component
    456 COPYRIGHT Ó 2014 BY THE JOURNAL OF BONE AND JOINT SURGERY,INCORPORATED Tibialis Posterior Tendon Transfer Corrects the Foot DropComponentofCavovarusFootDeformity in Charcot-Marie-Tooth Disease T. Dreher, MD, S.I. Wolf, PhD, D. Heitzmann, MSc, C. Fremd, M.C. Klotz, MD, and W. Wenz, MD Investigation performed at the Division for Paediatric Orthopaedics and Foot Surgery, Department for Orthopaedic and Trauma Surgery, Heidelberg University Clinics, Heidelberg, Germany Background: The foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease is commonly treated by tendon transfer to provide substitute foot dorsiflexion or by tenodesis to prevent the foot from dropping. Our goals were to use three-dimensional foot analysis to evaluate the outcome of tibialis posterior tendon transfer to the dorsum of the foot and to investigate whether the transfer works as an active substitution or as a tenodesis. Methods: We prospectively studied fourteen patients with Charcot-Marie-Tooth disease and cavovarus foot deformity in whom twenty-three feet were treated with tibialis posterior tendon transfer to correct the foot drop component as part of a foot deformity correction procedure. Five patients underwent unilateral treatment and nine underwent bilateral treatment; only one foot was analyzed in each of the latter patients. Standardized clinical examinations and three-dimensional gait analysis with a special foot model (Heidelberg Foot Measurement Method) were performed before and at a mean of 28.8 months after surgery. Results: The three-dimensional gait analysis revealed significant increases in tibiotalar and foot-tibia dorsiflexion during the swing phase after surgery. These increases were accompanied by a significant reduction in maximum plantar flexion at the stance-swing transition but without a reduction in active range of motion.
    [Show full text]
  • Reconstruction of Chronic Achilles Tendon Rupture Using the Semitendinosus Tendon : a Case Report
    417 CASE REPORT Reconstruction of chronic Achilles tendon rupture using the semitendinosus tendon : a case report Makoto Takeuchi, Naoto Suzue, Tetsuya Matsuura, Kosaku Higashino, Toshinori Sakai, Daisuke Hamada, Tomohiro Goto, Yoichiro Takata, Toshihiko Nishisho, Yuichiro Goda, Ryosuke Sato, Ichiro Tonogai, Kazuaki Mineta, and Koichi Sairyo Department of Orthopedics, the University of Tokushima, Tokushima, Japan Abstract : Achilles tendon rupture is a common trauma requiring surgical management. For chronic Achilles tendon rupture in particular, reconstructive surgery is desirable and several methods have been described. Here we present a case of chronic Achilles tendon rupture reconstructed using the semitendinosus tendon because of the difficulty in pulling down the proximal stump to reach the distal stump and due to an insufficient margin for hooking a suture to the distal stump. Postoperatively, the patient had a fully functional tendon and resumed his normal activities of daily living. Using this surgical technique, we expect favorable outcomes in cases of Achilles tendon rupture. J. Med. Invest. 61 : 417-420, August, 2014 Keywords : Achilles tendon reconstruction, chronic rupture, semitendinosus tendon INTRODUCTION technique over another has not been demonstrated and optimal surgical management of Achilles ten- Achilles tendon rupture represents more than 40% don rupture remains controversial (5). Among the of all tendon ruptures requiring surgical manage- available options, the semitendinosus tendon has ment (1). Although it can be managed conserva- been used for open reconstruction of chronic Achil- tively or operatively, the re-rupture rate of operative les tendon rupture with encouraging results (6). In treatment is typically lower than that of conserva- this report, we describe a case of chronic Achilles tive therapy (2, 3).
    [Show full text]
  • Morphology of the Patellar Tendon and the Contractility Response of the Quadriceps: Symmetry and Gender Analysis
    International Journal of Environmental Research and Public Health Article Morphology of the Patellar Tendon and the Contractility Response of the Quadriceps: Symmetry and Gender Analysis Pablo Abián 1 , Fernando Martínez 2, Fernando Jiménez 2 and Javier Abián-Vicén 2,* 1 Faculty of Humanities and Social Sciences, Comillas Pontifical University, 28049 Madrid, Spain; [email protected] 2 Performance and Sport Rehabilitation Laboratory, Faculty of Sport Sciences, University of Castilla-La Mancha, 45071 Toledo, Spain; [email protected] (F.M.); [email protected] (F.J.) * Correspondence: [email protected]; Tel.: +34-925268800 (ext. 5522) Abstract: The purpose of the study was to describe the differences between the dominant and non- dominant leg regarding contractility response and quadriceps strength and the morphology and stiffness of the patellar tendon (PT) in a group of physically active men and women. Fifty physically active subjects (36 men and 14 women) were evaluated for morphology and stiffness of the PT, contractility response of the rectus femoris of the quadriceps, isometric strength of the quadriceps and hamstrings, and isokinetic strength (concentric and eccentric) at 60◦/s of the knee extensors. The measurements were made on the subject’s dominant and non-dominant leg. The men showed a greater thickness of the PT in both legs compared to the women. Regarding the contractility response, the women recorded a 10.1 ± 16.2% (p = 0.038) greater contraction time (ct) in the dominant versus Citation: Abián, P.; Martínez, F.; the non-dominant leg and the men recorded 11.9% (p = 0.040) higher values in the dominant leg Jiménez, F.; Abián-Vicén, J.
    [Show full text]
  • Achilles Tendon Rupture Treated with Vacoped® Boot
    Achilles tendon rupture treated with VACOped® Boot: rehabilitation programme and exercises Information for patients from the Trauma and Orthopaedics (T&O) Team and Therapies Department This sheet is designed to give you an outline of how your rehabilitation will progress as you recover from your Achilles tendon rupture. It is only a guide and can be changed to meet your individual needs. The following time frame is a guide and may change depending on your individual progress. If you are fitted into a VACOped® Boot out of hours, please contact the William Harvey Hospital Fracture Clinic on the number 01233 616235, and provide your name, date of birth, and date of injury. We will make sure you are appropriately followed-up. What is an Achilles tendon rupture and what are the benefits of the VACOped® Boot? An Achilles tendon rupture is a break of the tendon that is at the back of your ankle and connects the calf with the back of your foot. When that tendon breaks, it affects gait and walking. In order to heal the tendon, you need both ends to be brought closer together. For that to happen, you need to have your foot pointing down (equinus position) and to have your movement restricted for the first four weeks. After that, you can start moving gently. Wearing the VACOped® Boot can help this to happen more easily. The treatment with the boot will take about nine to 10 weeks (unless advised otherwise). However, full recovery can take up to a year, so you need to be aware and sensible about your affected leg, follow the advice from the professionals looking after you, and do not push yourself too much, as there is a risk for your Achilles tendon to re-rupture.
    [Show full text]
  • Musculoskeletal Ultrasound Technical Guidelines VI. Ankle
    European Society of MusculoSkeletal Radiology Musculoskeletal Ultrasound Technical Guidelines VI. Ankle Ian Beggs, UK Stefano Bianchi, Switzerland Angel Bueno, Spain Michel Cohen, France Michel Court-Payen, Denmark Andrew Grainger, UK Franz Kainberger, Austria Andrea Klauser, Austria Carlo Martinoli, Italy Eugene McNally, UK Philip J. O’Connor, UK Philippe Peetrons, Belgium Monique Reijnierse, The Netherlands Philipp Remplik, Germany Enzo Silvestri, Italy Ankle Note The systematic scanning technique described below is only theoretical, considering the fact that the examination of the ankle is, for the most, focused to one (or a few) aspect(s) only of the joint based on clinical findings. 1 ANTERIOR ANKLE: extensor tendons Patient seated on the examination bed with the knee flexed 45° so that the plantar surface of the foot lies flat on the table. Alternatively, the patient may lie supine with the foot free to allow manipulation by the examiner during scanning. Place the transducer in the axial plane and sweep it up and down over the dorsum of the ankle to examine the tibialis anterior, extensor hallucis longus and extensor digitorum longus. These tendons must be examined in their full length starting from the myotendinous junction. Look at the tibialis anterior artery and the adjacent deep peroneal nerve. ehl ehl edl a ta v Talus Be sure to examine the superior extensor retinaculum and the insertion of the tibialis ante- rior tendon, which lies distally and medially. Follow the tibialis anterior tendon up to reach its insertion onto the first cuneiform. Legend: a, anterior tibial ar- tery; edl, extensor digitorum longus tendon; ehl, exten- sor hallucis longus tendon; ta, tibialis anterior tendon; void arrows, distal tibialis anterior tendon; v, anterior tibial vein; void arrowheads, Cuneiform1 superior extensor retinacu- lum; white arrowhead, deep peroneal nerve 1 Ankle 2 anterior recess of the ankle joint Place the transducer in the mid longitudinal plane over the dorsum of the ankle to examine the anterior re- cess of the tibiotalar joint.
    [Show full text]
  • The Achilles Tendon Is a Strong, Fibrous Band That Connects the Calf
    40 Allied Drive Dedham, MA 02026 781-251-3535 (office) www.bostonsportsmedicine.com ACHILLES TENDON RUPTURE ANATOMY The Achilles tendon is a strong tendon that connects the calf muscles to the heel. The calf is formed by two muscles: the underlying soleus muscle and the thick outer gastrocnemius muscle. When they contract, they pull on the Achilles tendon causing your foot to point down (plantar flexion)and helping you raise up on your toes. This powerful muscle group helps when you sprint, jump, or climb. With aging and overuse, the Achilles tendon is subject to degeneration within the substance of the tendon. The term degeneration means that wear and tear occurs in the tendon over time and leads to a weakening of the tendon. Degeneration in a tendon usually shows up as a loss of the normal arrangement of the fibers of the tendon. Tendons are made up of strands of a material called collagen (think of a tendon as similar to a nylon rope with the strands of collagen being the nylon strands). Some of the individual strands of the tendon become jumbled due to the degeneration, other fibers break, and the tendon loses strength. The healing process in the tendon can cause the tendon to become thickened as scar tissue tries to repair the tendon. This process can continue to the extent that a nodule forms within the tendon. This condition is called tendinosis. The area of tendinosis in the tendon is weaker than normal tendon and is usually painful. Spontaneous rupture of the Achilles tendon can occur in patients in their third to fifth decade.
    [Show full text]
  • Organization of the Lower Limb Audrone Biknevicius, Ph.D
    www.thestudio1.co.za Organization of the Lower Limb Audrone Biknevicius, Ph.D. Dept. Biomedical Sciences, OU HCOM at Dublin Clinical Anatomy Immersion 2015 LIMB FUNCTION choco-locate.com blog.coolibar.com Mobility versus Body weight support Dexterity Locomotion Equilibrium & Stability 2 Pectoral Girdle Pelvic Girdle Mobility versus Body weight support Dexterity Locomotion Equilibrium & Stability 3 Arm – forearm – hand Thigh – leg – foot 4 CORRECTED SLIDE #5 The upper and lower limbs are innervated by: A. Posterior (dorsal) rami of spinal nn. B. Anterior (ventral) rami of spinal nn. 50% 50% Posterior (dorsal) rami of spin.. Anterior (ventral) rami of sp... 5 Week 5 RULE #1 Limbs are outgrowths of the ventral body wall Upper limb: C5-T1 trunk segments Lower limb: L2-S3 trunk segments (morphogenesis ~1-2 days later) 6 Week 7 RULE #1 (continued) Limbs are outgrowths of the ventral body wall that undergo distal growth, differentiation and rotation 7 Before rotation en.wikipedia.org • Pollex and hallux both preaxial • Anteriomedially-directed palms and soles 8 Post rotation embryology.med.unsw.edu.au Upper limb rotates 90◦ laterally: Lower limb rotates 90◦ medially: -Extensor mm. on posterior surface -Extensor mm. on anterior surface -Future elbow directed posteriorly -Future knee directed anteriorly -Supine hand in anatomical position -Foot fixed in prone position -Pollex positioned laterally -Hallux positioned medially 9 RULE #2: Innervation of lower limb mm. established in early embryogenesis – resulted in dedicated nerve-compartment relationships Spinal nerve Dorsal primary ramus Ventral primary ramus (L2-S3) Anterior (ventral) division Posterior (dorsal) division limb axis 10 Stern Essential of Gross Anatomy “Roots of BP” Brachial Plexus (=ventral rami) (right side; simplified) C5 Trunks C6 Divisions U C7 Cord M C8 Lat L Terminal T1 Branches Post Musculocutaneous n.
    [Show full text]
  • Treatment of Spastic Foot Deformities
    TREATMENT OF SPASTIC FOOT DEFORMITIES penn neuro-orthopaedics service Table of Contents OVERVIEW Severe loss of movement is often the result of neurological disorders, Overview .............................................................. 1 such as stroke or brain injury. As a result, ordinary daily activities Treatment ............................................................. 2 such as walking, eating and dressing can be difficult and sometimes impossible to accomplish. Procedures ........................................................... 4 The Penn Neuro-Orthopaedics Service assists patients with Achilles Tendon Lengthening .........................................4 orthopaedic problems caused by certain neurologic disorders. Our Toe Flexor Releases .....................................................5 team successfully treats a wide range of problems affecting the limbs including foot deformities and walking problems due to abnormal Toe Flexor Transfer .......................................................6 postures of the foot. Split Anterior Tibialis Tendon Transfer (SPLATT) ...............7 This booklet focuses on the treatment of spastic foot deformities The Extensor Tendon of the Big Toe (EHL) .......................8 under the supervision of Keith Baldwin, MD, MSPT, MPH. Lengthening the Tibialis Posterior Tendon .......................9 Care After Surgery .................................................10 Notes ..................................................................12 Pre-operative right foot. Post-operative
    [Show full text]
  • 899. the Foot Arch and Viscoelastic Properties of Plantar Fascia and Achilles Tendon
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Journal of Vibroengineering 899. The foot arch and viscoelastic properties of plantar fascia and Achilles tendon Raminta Sakalauskaitė 1, Danguolė Satkunskienė 2 1, 2Lithuanian Academy of Physical Education, Lithuania 2Kaunas University of Technology, Lithuania 1 2 E-mail: [email protected] , [email protected] (Received 2 September 2012; accepted 4 December 2012) Abstract. Plantar fascia reduces ground reaction force on metatarsal heads. It serves to stiffen medial and lateral longitudinal arches and reduce longitudinal arch flattening. Mechanical characteristics of plantar fascia and Achilles tendon can provide significant information on fascia and tendon functional condition as well as the risks of irregularities. The objectives of this study were: (a) to identify plantar fascia and Achilles tendon oscillation frequency, decrement and stiffness, and to evaluate the reliability of differences between normal, low and high foot arch; (b) to identify the relation between plantar fascia and Achilles tendon mechanical characteristics. 42 feet of 21 soccer players were investigated in order to determine plantar fascia and Achilles tendon oscillation frequency, decrement and stiffness of feet with normal, low and high foot arch. 164 feet of 32 soldiers, 21 football players and 29 basketball players were analyzed to determine the link between plantar fascia and Achilles tendon mechanical characteristics. The medial longitudinal foot arch was evaluated according to arch index by Williams (WAI). The Achilles tendon and plantar fascia oscillation frequency, decrement and stiffness were evaluated using Myoton-3 system. This study revealed that relaxed plantar fascia of feet with normal arch is statistically reliably more elastic than fascia of feet with low arch.
    [Show full text]
  • Achilles Tendinopathy
    Tyneside Integrated Musculoskeletal Service Information for Patients www.tims.nhs.uk Achilles Tendinopathy Introduction The purpose of this leaflet is to provide you with some general advice about Achilles Tendinopathy, how to manage your pain and some simple exercises. What is Achilles Tendinopathy? Achilles tendinopathy (tendinosis) is a common condition that affects the tendon that connects your calf muscles to the heel bone (calcaneus).The Achilles tendon is the strongest in the body, allowing you to push up the weight of your body onto your tiptoes. It therefore takes a lot of stress as you walk. Sometimes due to increased or abnormal stress to the tendon (i.e. a sudden increase of activity such as running, jumping or standing for longer periods), the tendon can become painful and swelling and stiffness can occur. Certain activities (such as running, jumping) will need to be modified to allow the tendon to settle down and heal. For most people the symptoms of Achilles tendinopathy usually clear within 3-6 months from starting your rehabilitation. What are the symptoms Achilles Tendinopathy? Achilles tendinopathy pain is usually felt above the heel and into the lower portion of your calf. It tends to feel very stiff in the morning which improves after a few minutes walking. The tendon itself can sometimes become swollen and tender to touch. The level of pain itself can vary from soreness after exercising to severe pain that limits exercise entirely. How is this condition diagnosed? Achilles tendinopathy is usually diagnosed by a health professional following assessment. Scans/x-rays are not usually needed.
    [Show full text]
  • Evaluation of the Tibialis Posterior and Achilles Tendons
    CHAPTER 47 EVALUATION OF THE TIBIALIS POSTERIOR AND ACHILLES TENDONS M.Iay Groues, D.P.M. The Achilles and tibialis posterior rendons are the Achilles is covered more superficially by the crural most commonly affected in the foot and ankle. fascia, superficial fascia and skin; anterior to the Injury, degeneration and dysfunction of these tendon is the pre-Achilles fat pad (of Kagar's tendons can result from both metabolic conditions triangle) (Fig. 2). The tendon measures 5 mm to 6 and mechanical forces. mm thick at the ankle, and 7.2 cm to 2.5 cm in Systemic conditions such as rheumatoid and width at the insertion. seronegative afihritis, as well as chronic steroid ingestion, may cause pathologic tendon degenera- tion or rupture. Familial hypercholesterolemia and hyperlipidemia may create xanthoma deposition in the Achilles tendon. These asymptomatic and painless lesions do not predispose the tendon to l'r-rpture, but are important in the diagnosis and early treatment of these diseases. Pathologic mechanical forces can also be responsible for tendon injury. When the Achilles and tibialis posterior tendon pathology remain undiagnosed, foot and ankle function usually deteriorates, causing irreversible deformity. Early diagnosis and treatment allows the most favorable and functional outcome. Accurate evaluation of Figure 1. Note the oval appearance of the Achilles tendon near its insertion. Achilles and tibialis posterior tendinopathy involves a thorough understanding of the anatomy, kinesiology, patient history, physical examination, and imaging of these tendons. ANATOMY & KINESIOLOGY Achilles Tendon The calcaneal tendon is one of the thickest and strongest tendons in the body. In addition to providing heel lift during gait, the soleal and gastrocnemius muscles assist with knee extension and flexion.
    [Show full text]