PREFERRED PRACTICE PATTERN3
4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation
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.
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
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.)
People participating in athletic activity; condition can also occur in sedentary individuals
Age: Between 30 and 50 years of age (median)4
Sex: Males more than females4
Onset more common during training versus competitive event
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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