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Question : the achilles tendon
Correct answer: the tendons of the gastrocnemius and
soleus fuse to become one tendon, about 5 to 6 cm proximal to the calcaneal insertion, usually 50/50 form gastroc and soleus -the thickest and strongest tendon in the body -this tendon has no synovial sheath but is surrounded by paratendon, which wraps around it and receives blood flow -so it is a vascular tendon bc it is surrounded by paratenon
Question : where is the retrocalcaneal bursa
Correct answer: this is proximal to the achilles tendon
insertion to the calcaneus, between the tendon and the calcaneus -this can be pinched
Question : what could the cause of posterior heel pain
Correct answer: -could be achilles tendonitis, achilles
bursitis, or retrocalcaneal bursitis
-we need to look exactly where the pain is -true tendon pain is only directly on the tendon, not around it
Question : Retrocalcaneal Bursitis
Correct answer: this is a fluid filled sac that stops the
achilles tendon from rubbing across bone -this bursa is between the anterior inferior side of the achilles tendon and the posteriorsuperior aspect of the calcaneus -this is sometimes seen w insertional tendinopathy, so an issue w the tendon causes bursa to get irritated
- structural irritants too so tight or pokey
-pain will be just above the insertion of achilles, but not directly on tendon -pain with squeeze from side and behind tendon
Question : achilles bursitis (superficial calcaneal bursitis)
Correct answer: -aka the subcutaneous bursa
-the bursa is located between the calcaneal prominence or achilles tendon and the skin, so at bottom of achilles -pain w posterior aspect of heel w solid swelling, so pain below achilles -this is often due to excessive friction or by wearing shoes that are too tight or too large -there will be swelling, but wont be soft
Question : management of an "itis" in posterior heel
Correct answer: -this is when there is inflammation
-do POLICE/PEACE and LOVE -address training and equipement issue -we want to calm down swelling -Heel lift takes pressure off achilles -pad around pain w a donut so there is no pressure directly on bursda -stretch achilles by stretching gastroc and soleus
Question : what is tendinotis or paratendinitis in ankle
Correct answer: -tendinitis is inflammation of tendon,
this is pretty rare, from gastroc, soleus or other muscle in ankle -paratendonitis is inflammation, pain, and crepitattion of the paratendon as it slides over the structure (creeking noise and feel) -this is a acute irritation, so too much too soon (increase FITT, not enough rest)
Question : what are the internal and external factors that
contribute to tendonitis and paratenonitis in ankle
Correct answer: -externla factors like rub from shoe,
running down hill (tibialis anterior bc has to pronate in plantarflexion so added stress) ,rubbing form laces in
tibilais anterior, ot hyperdorsiflexion (achilles from running uphill) -internal factors could be foot malalignment, so improper rub over bone, cavus or flat/pronating feet
Question : what are signs and symptoms of tendonitis or
paratenonitis in ankle
Correct answer: -there is pain and/or crepitation of
paratenon of acute onset -red and hot over involved structure -usually preciptated by movement around ankle movement that was too much, too soon -the diagnosis is made on the basis of local swelling -look at STTT -there will be pain on palpation only over the direct tendon
Question : what is the usually rehab for ankle
paratenonitis Correct answer: inflammatory phase: POLICE/PEACE and LOVE, use heel lift, pad, support
-repair phase: heat to increase blood flow, idealize ROM,
so stretch gastroc and soleus -start strength and proprioception ex as able, could also do balance exercise -address the training issues