Achilles Tendon Injury Study Notes

Achilles Tendon Injury
1. Anatomy:
2. Pathology:
– Achilles tendonitis
– Achilles tendon rupture
– Achilles tendon avulsion

Anatomy
• Largest tendon in the body
• Achilles tendon forms from the union of gastrocnemius (medial and lateral) and soleus tendons
• Blood supply: posterior tibial artery Imaging
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Figure 1. Normal MRI of the Achilles tendon demonstrates this to be a well defined hypointense (dark) structure (arrow) inserting onto the calcaneus, thereafter becoming continuous with the plantar fascia (arrow).
Figure 2: Ultrasound of a normal Achilles tendon depicts the multiple small fibrils that make up the tendon as alternating bright and dark lines (arrow). Note the calcaneal insertion.

Achilles Tendonitis
1.

Risk factors:
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2.

Chronic overuse of calf muscle (runners, dancers, gymnasts, tennis players injury)
Rheumatological conditions (e.g. Spondylarthropathy, rheumatoid arthritis)

Clinical Presentation
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3.

Sharp heel pain and stiffness at the mid-achilles tendon to insertion (exercise>walking)

Clinical examination
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4.

Inflammation – pain, local tenderness, swelling (from calcaneal insertion [insertional tendonitis] to 3-5cm above calcaneal insertion [true achilles tendonitis])
Dry crepitus
Achilles peritendonitis (involves inflammation of tendon sheath)

Radiology
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5.

Ankle XRay may show spurring at the achilles tendon insertion
USS: tendon thickening
MRI: Figure 4: MRI of severe Achilles tendinosis is characterised by marked thickening, increased signal intensity (brightness) and areas of intrasubstance tearing of the tendon, placing the tendon at risk of full thickness rupture.

Management
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NSAIDs for 10/7
RICE, limit/avoid running, walk on flat surfaces, cross-training e.g.
Swimming or riding
Rehab: gentle stretching and strengthening
Podiatry referral: orthotics

Achilles Tendon Rupture
1.

Incidence :
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2.

18