43: Insertional Achilles Tendonitis - Smith Flashcards Preview

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1

insertional achilles tendinitis aka

posterior/retro calcaneal pain

2

etiology of haglund's deformity ***

- Cavus Foot
- Compensated Rearfoot Varus
- Forefoot Valgus
- Plantarflexed First Ray
- Overuse/poor training
- Systemic diseases
- Shape of calcaneus
- Equinus

3

bump directly at insertion of achilles tendon

retrocalcaneal bursitis/exostosis

4

bursa between achilles tendon and calcaneus

retrocalcaneal bursa

could have an abnormal bursa form on the posterior surface of calcaneus too

5

s/s haglund's deformity

Dull ache
Aggravated by shoe gear
High heel shoes?
Women 20-30

6

PE haglund's deformity ***

Erythema
Edema
Pain on palpation
Pump bump
Hyperkeratosis

7

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

8

normal calcaneal inclinantion angle

25 degrees
flatfoot smaller
cavus foot higher

9

treatment haglund's deformity ***

Heel Lift
Open Shoe
Orthotics
NSAID’S
Ice
Physical Therapy
Injections?
Surgery

10

surgical incisions for haglund's deformity

- Fowler and Philip
- Lateral Linear * most commonly used
- Lateral Lazy L
- Two Incisional

11

where is haglund's deformity?

posterolateral aspect of calcaneus

12

"chasing the bump"

- resect more bone than planned because trying to smooth the surface off
- compromises the achilles tendon insertion

13

post op management for haglund's deformity surgery

- Short Leg Cast 4 Weeks
- Unna Boot With Heel Lift 10 Days
- Physical Therapy

14

describe a retrocalcaneal exostosis

- Exostosis with or without spurring at Achilles Tendon insertion
- May see calcification of tendon, bursitis, tendinitis or Haglund’s deformity

15

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)

16

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

17

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

18

potential complications of surgery

- Achilles Tendon rupture
- Scar
- Nerve entrapment
- Equinus
- Wound dehiscence
- Fracture
- Recurrence