Achilles tendon disorders

Question 1

What is the most common cause of posterior heel pain?

Answer 1

Achilles tendon disorders

Question 2

List 3 presentations of Achilles tendon disorders

Answer 2

Tendinopathy (Tendinitis)
Partial tear of the Achilles tendon.
Complete rupture of the Achilles tendon.

Question 3

Name 2 risk factors for Achilles tendon disorders

Answer 3

Quinolone use (e.g. ciprofloxacin) is a/w tendon disorders
Hypercholesterolaemia (predisposes to tendon xanthomata)

Question 4

Give 2 symptoms of achilles tendinitis

Answer 4

Gradual onset of posterior heel pain, worse following activity

Morning pain + stiffness

Question 5

Describe management for achilles tendonitis

Answer 5

Supportive
Simple analgesia
Reduction in precipitating activities
Calf muscle eccentric exercises: self-directed or under guidance of PT

Question 6

Under which circumstances should achilles tendon rupture be suspected?

Answer 6

Whilst playing sport/ running;
audible pop in the ankle
sudden onset significant pain in calf/ ankle
inability to walk/ continue sport

Question 7

What should be used to conduct an examination to exclude Achilles tendon rupture?

Answer 7

Simmond’s triad

Question 8

How is Simmond’s triad performed?

Answer 8

Ask patient to lie prone with feet over edge of bed
Look for abnormal angle of declination
Rupture may lead to greater dorsiflexion of injured foot vs uninjured
Also feel for gap in tendon + gently squeeze calf: if acute rupture, injured foot will stay in neutral position

Question 9

What is the initial imaging modality of choice for achilles tendon rupture?

Answer 9

US

Question 10

Describe management of achilles tendon rupture?

Answer 10

Acute referral made to orthopaedic specialist