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CONDITION/DISORDER SYNONYMS

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  • Achilles tendinitis

  • Achilles tendonitis

  • Achilles tendinosis

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ICD-9-CM CODE1

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  • 726.71 Achilles bursitis or tendonitis

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ICD-10-CM CODE2

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  • M76.60 Achilles tendinitis, unspecified leg

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PREFERRED PRACTICE PATTERN3

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  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation

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PATIENT PRESENTATION

A 37-year-old man presents complaining of pain in his left heel. Pain began 3 weeks ago when he increased his total running distance from 20 miles per week to 40 miles per week. He indicates pain worsens with running and stair climbing. Palpation reveals tenderness in the middle portion of his Achilles tendon. Examination reveals he is lacking 15 degrees of passive dorsiflexion compared to his uninvolved side and is unable to perform greater than five single leg calf raises due to pain. The patient tests negative for neural dynamics tests of the lower extremities.

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KEY FEATURES
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Description
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  • Insertional Achilles tendinitis: Fibers in middle portion of the tendon breakdown, degenerate, swell, thicken

  • Noninsertional Achilles tendonitis: Pain in lower portion of heel at tendon attachment

  • Pain common at midportion of the Achilles tendon

  • Typically lacks presence of inflammatory cells, probably more tendonosis than tendonitis

  • Typically associated with tissue degeneration

    • Two types

      • Lipoid: Fatty tissue deposited in the tendon

      • Mucoid: Conversion of the tendon in softer material with gray or brown appearance

    • Thickening of the tendon

    • Neovascularization

    • Increased presence of varicose nerve fibers

      • Most likely source of pain

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FIGURE 202-1

Achilles tendinitis. (A) Photograph of a patient with a prominence in the area of the posterior superior aspect of the calcaneus. (B) Lateral view radiograph of same patient demonstrating that an insertional calcific Achilles tendinitis, not Haglund deformity, is the cause of this deformity. (From Imboden J, Hellmann DB, Stone JH. Current Diagnosis & Treatment in Rheumatology. 2nd ed. http://www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
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Essentials of Diagnosis
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  • Patient history and clinical examination

  • Ultrasound or MRI imaging

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General Considerations
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  • Address training errors and biomechanics deficits to prevent recurrence

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Demographics
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  • People participating in athletic activity; condition can also occur in sedentary individuals

    • Runners: 7% to 9% prevalence4

  • Age: Between 30 and 50 years of age (median)4

  • Sex: Males more than females4

  • Onset more common during training versus competitive event

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CLINICAL FINDINGS
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SIGNS AND SYMPTOMS

  • Pain with palpation of tendon 2 to 6 cm proximal to the insertion

  • Pain back of the heel

  • Tenderness changes position with tendon movement during dorsiflexion and plantar flexion (arc sign)

  • Increased swelling throughout ...

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