Ankle & foot summarised

Question 1

ACHILLES TENDON INJURIES classification

Answer 1

• Must decipher whether the tendon is ruptured or not ruptured
  If it is not ruptured it is further classified as to whether the problem exists at the attachment site of the Achilles on the calcaneus “insertional” or if symptoms exist proximal to this area “noninsertional”

Question 2

Non insertional tendinosis

Answer 2

• When there is actual intratendinous degeneration of the Achilles tendon proximal to its attachment on the calcaneus
• Tendon is typically swollen
• Onset of symptoms is insidious and located within the midsubstance of the tendon
• Its not called ‘tendonitis’ because history reveals no true inflammatory component instead a fibromyxoid degenerative tissue with a high water content replaces normal tendon
• Likely due to the tendon having a sparse cellularity and vascularity
  o Both of which impair the inflammatory process
• As a result, the tendon becomes thicker, softer, and yellowish
• Degeneration of the tendon is often insidious and asymptomatic
• Swelling and pain typically 4cm proximal to the distal insertion of the Achilles

Question 3

Insertional tendinosis

Answer 3

• An inflammatory condition
• Occurs at or around the Achilles tendon insertion into the calcaneus

Question 4

Rupture

Answer 4

• Most common tendinous rupture in the lower extremity
• Peak incidence in the 3rd to 5th decades and occurs 5 times more often in males
• Described in middle-aged athletes who have experienced a sudden pain with an audible “pop” in the back of the heels
• Many report a sensation of being hit even when they haven’t