Flashcards in 43: Insertional Achilles Tendonitis - Smith Deck (18)
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insertional achilles tendinitis aka
posterior/retro calcaneal pain
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etiology of haglund's deformity ***
- Cavus Foot
- Compensated Rearfoot Varus
- Forefoot Valgus
- Plantarflexed First Ray
- Overuse/poor training
- Systemic diseases
- Shape of calcaneus
- Equinus
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bump directly at insertion of achilles tendon
retrocalcaneal bursitis/exostosis
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bursa between achilles tendon and calcaneus
retrocalcaneal bursa
could have an abnormal bursa form on the posterior surface of calcaneus too
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s/s haglund's deformity
Dull ache
Aggravated by shoe gear
High heel shoes?
Women 20-30
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PE haglund's deformity ***
Erythema
Edema
Pain on palpation
Pump bump
Hyperkeratosis
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radiographic angles associated with haglund's deformity ***
Fowler And Philip Angle 75° (65°)
- increased with deformity
Total Angle 90° - Ruch
- combines fowler and philip with calcaneal inclination
Parallel Pitch Lines - Pavlov
- line on inferior calcaneus and line on superior calcaneus
- bone above the second pitch line is a haglund's deformity
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normal calcaneal inclinantion angle
25 degrees
flatfoot smaller
cavus foot higher
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treatment haglund's deformity ***
Heel Lift
Open Shoe
Orthotics
NSAID’S
Ice
Physical Therapy
Injections?
Surgery
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surgical incisions for haglund's deformity
- Fowler and Philip
- Lateral Linear * most commonly used
- Lateral Lazy L
- Two Incisional
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where is haglund's deformity?
posterolateral aspect of calcaneus
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"chasing the bump"
- resect more bone than planned because trying to smooth the surface off
- compromises the achilles tendon insertion
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post op management for haglund's deformity surgery
- Short Leg Cast 4 Weeks
- Unna Boot With Heel Lift 10 Days
- Physical Therapy
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describe a retrocalcaneal exostosis
- Exostosis with or without spurring at Achilles Tendon insertion
- May see calcification of tendon, bursitis, tendinitis or Haglund’s deformity
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types of calcification of achilles tendon
Type I:
continuous with calcaneal insertion (microtrauma, biomechanical
related, SNA)
Type II:
insertion zone, separated from the os calcis (ACC, pseudogout)
Type III:
proximal to insertion zone (trauma, post-surgical, Wilson disease, ischemia)
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s/s retrocalcaneal exostosis
- Etiology similar to Haglund’s deformity
- Dull aching pain, tenderness AT INSERTION
- Achilles Tendon thickening
- Pain with ROM and palpation
- Equinus
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surgical tx retrocalcaneal exostosis
- Resection of exostosis
- Splitting Achilles Tendon or removing it from calcaneus
- long recovery time
- Keck and Kelly
- Wedge osteotomy in body to relocate the posterior insertion to a more anterior and superior position (can also be used for Haglund’s)
- doesn't compromise the achilles tendon insertion
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