Overview of Insertional Achilles Tendinopathy

Overuse injury of the Achilles tendon is becoming a more common problem in the United States as the younger population becomes more athletic and as elderly patients assume ever-increasing levels of physical activity. Thus, it is not surprising that the Achilles tendon, one of the largest tendons in the body, would be subjected to repetitive overuse injuries in both patient populations. This overuse phenomenon can ultimately lead to different forms of Achilles tendinopathy. It is important at...

Indications and Contraindications for Surgical Reconstruction

Resonancia Magnetica Pulmonar

The local chronically affected tissue has only poor healing capacity, and the affected area usually lies in the watershed area of the tendon. 17Therefore, Fig. 10.4. (A) In this 43-year-old runner who had sustained an ankle sprain 9 months prior, MRI revealed an incomplete rupture of the Achilles tendon. (B,C) The gap was filled with hypertrophic scar tissue, which led to the clinical diagnosis of tendonitis Fig. 10.4. (A) In this 43-year-old runner who had sustained an ankle sprain 9 months...

Open Achilles Tendon Debridement with Repair

Positioning Tourniquet Use Anesthesia The patient may be positioned either prone or supine with a bump under the opposite hip. A tourniquet is optional. If a tourniquet is utilized, a thigh tourniquet offers the advantage over a calf tourniquet of preserving unrestricted gastrocnemius-soleus mobility during surgery. Anesthesia ranges from regional to general and is dictated by surgeon preference and tourniquet use. We prefer to place the patient in the prone position, use a thigh tourniquet,...

Treatment

A poor understanding of the natural history of noninsertional tendinopathy contributes to a lack of full understanding of the role of intervention. The multitude of conservative and surgical treatment strategies advocated for noninsertional tendinopathy implies a lack of a single definitive treatment approach. Treatment is largely supported only by retrospective data and empirically derived algorithms rather than evidence-based outcome studies. This discussion focuses on nonoperative management...

Case Study 2

A 57-year-old man had a history of diabetes and peripheral vascular disease. A previous lower extremity bypass procedure on the involved extremity had been performed with a saphenous vein graft from the same leg. The patient suffered an Achilles tendon rupture of his left leg that was primarily repaired and the soft tissue closed directly. Subsequently, the patient developed a wound infection leading to the destruction of local soft tissue. The Achilles tendon repair was intact and the tendon...

Case Study 1 Chronic Achilles Rupture

A 28-year-old policewoman injured her right ankle while boxing 3 months prior to presentation in the office. She was pursuing a career as a professional fighter at the time of injury. After reporting to the emergency room, she was diagnosed with a severe ankle sprain and placed into a stirrup ankle brace. At 6 weeks postinjury, she attempted to return to boxing, noting both pain and lack of push-off strength with her right lower extremity. She sought medical attention under her primary care...

Functional Rehabilitation Protocol

Following repair of the tendon intraoperatively, the patient is placed into a bulky splint in 20 degrees of plantarflexion in order to minimize swelling and maximize skin perfusion.31 The patient is non-weight bearing on the operative side and is instructed to keep the leg elevated in order to minimize wound complications. At 2 weeks, the postoperative splint is removed and the patient is placed into a removable cam walker. The goal at this time is to allow the patient to begin weight bearing...

Kush Singh and Clyde A Helms

Achilles Tendon Mri Section Images

Several different clinical scenarios warrant evaluation of the Achilles tendon with magnetic resonance imaging (MRI). However, the main reasons to image the Achilles are pain, trauma, infection, or a mass. Less commonly, an MRI may be used to screen for hypercholesterolemia. Although a diagnosis of Achilles tendon rupture is usually evident clinically, the gap between the ruptured ends of the tendon may be difficult to ascertain by physical examination alone. This gap is frequently used to...

Joseph Yu and William E Garrett Jr

Calf Muscle Tear Ultrasound

In 1883, Powell1 first reported in The Lancet on the lawn tennis leg (rupture of the medial head of the gastrocnemius). He described a 41-year-old healthy man who had sudden, sharp pain when reaching for the ball while playing tennis. Pain, tenderness, and swelling rapidly developed, but the patient was able to return to sports in 4 weeks. In 1958, Arner and Lindholm2 surgically explored five of 20 patients with tennis leg. In each case, a transverse rupture of the medial gastrocnemius at the...