Abstract
The onset of Achilles tendinitis is usually acute, occurring after overuse or misuse of the ankle joint. Inciting activities include running with sudden stops and starts, such as when playing tennis. Improper stretching of the gastrocnemius and Achilles tendon before exercise has also been implicated in Achilles tendinitis, as well as in acute tendon rupture. The pain of Achilles tendinitis is constant and severe and is localized in the posterior ankle. Significant sleep disturbance is often reported. Patients may attempt to splint the inflamed Achilles tendon by adopting a flatfooted gait to avoid plantar flexing the tendon. Pain is induced with resisted plantar flexion of the foot, and a creaking or grating sensation may be palpated when the foot is passively plantar flexed. A chronically inflamed Achilles tendon may suddenly rupture from stress or during injection into the tendon itself.
Keywords
Achilles tendinitis, Achilles tendon, Achilles tendon rupture, ankle pain, sports injury, magnetic resonance testing, diagnostic sonography, ultrasound guided injection, creak sign
ICD-10 CODE M65.879
Keywords
Achilles tendinitis, Achilles tendon, Achilles tendon rupture, ankle pain, sports injury, magnetic resonance testing, diagnostic sonography, ultrasound guided injection, creak sign
ICD-10 CODE M65.879
The Clinical Syndrome
Achilles tendinitis has become more common as jogging has increased in popularity. The Achilles tendon is susceptible to the development of tendinitis both at its insertion on the calcaneus and at its narrowest part, a point approximately 5 cm above its insertion. The Achilles tendon is subjected to repetitive motion that may result in microtrauma, which heals poorly owing to the tendon’s avascular nature. The appearance of Achilles tendinitis has been described as having a crab meat appearance owing to the nonlinear orientation of the tendon fibers ( Fig. 126.1 ). Running is often the inciting factor in acute Achilles tendinitis, which frequently coexists with bursitis and thus causes additional pain and functional disability. Calcium deposition around the tendon may occur if inflammation persists, and this complication makes subsequent treatment more difficult. Continued trauma to the inflamed tendon may ultimately result in tendon rupture.
Signs and Symptoms
The onset of Achilles tendinitis is usually acute, occurring after overuse or misuse of the ankle joint. Inciting activities include running with sudden stops and starts, such as when playing tennis. Improper stretching of the gastrocnemius and Achilles tendon before exercise has also been implicated in Achilles tendinitis, as well as in acute tendon rupture. The pain of Achilles tendinitis is constant and severe and is localized in the posterior ankle ( Fig. 126.2 ). Significant sleep disturbance is often reported. Patients may attempt to splint the inflamed Achilles tendon by adopting a flatfooted gait to avoid plantar flexing the tendon. Pain is induced with resisted plantar flexion of the foot, and a creaking or grating sensation may be palpated when the foot is passively plantar flexed ( Fig. 126.3 ). A chronically inflamed Achilles tendon may suddenly rupture from stress or during injection into the tendon itself.
Testing
Plain radiographs, ultrasound imaging, and magnetic resonance imaging (MRI) are indicated in all patients who present with posterior ankle pain ( Figs. 126.4 and 126.5 ). MRI and ultrasound imaging of the ankle are also indicated if joint instability is suspected. Radionuclide bone scanning is useful to identify stress fractures not seen on plain radiographs. Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, comprehensive metabolic profile, and antinuclear antibody testing. The injection technique described later serves as both a diagnostic and a therapeutic maneuver.
