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Achilles Tendinopathy Insertional - Coggle Diagram
Achilles Tendinopathy Insertional
Subjective
May indicate sudden change or increase in loading activity.
Pain pattern = worse in AM or when starting activity, may then improve and then will return or feel worse 24 hours later.
Common in sports that involve running.
Insidious onset.
Likely taking part in regular activity where by the tendon is continually (chronic) loaded.
Objective
Palpation: Pain may run along Achilles tendon but should be more localised or proactive around insertion point at calcaneus.
Neuro - NAD
Observation: tendon may appear thicker, or have visible lump. Potential for wastage depending on chronicity.
Research
Emphasized the importance and reliance of loading as a treatment approach.
Treat the donut not the hole (hole is the pathology).
Local nociceptive issue not centrally sensitised.
State importance of tendon being able to manage fast loads. Mimic spring like function.
Critiqued eccentric and heavy slow resistance programmes.
Approach = unload tendon so it can settle, gradually reload, outlined 4 stages to rehab.
Jill Cook - key player - Informed coogle.
https://www.youtube.com/watch?v=-kKzoi8Zrik
Nonoperative treatment of insertional
Achilles tendinopathy: a systematic review. Zhi et al. 2021.
Current evidence for nonoperative treatment favors ESWT or the combined treatment of ESWT plus eccentric exercises.
NICE Guidelines -
https://cks.nice.org.uk/topics/achilles-tendinopathy/management/management/
Eccentric exercise, or a heavy-load, slow-speed (concentric/eccentric) exercise programme.
ESWT.
Why this and nothing else?
Link the repetitive load in subjective history.
Absence of trauma and neuro like symptoms.
The localised pain and increase activity with use.
Differentials
Tarsal tunnel syndrome
Calf pathology.
Mid portion Achilles.
Plantar fasciitis.
Stress fracture.
Retrocalcaneal Bursitis
Pathology
Change in load profile often being cause can be a acute or chronic issue.
Common overuse injury occurring an the insertion site of Achilles.
Jill Cook - "Inflammation does exist but not prime driver, collagen tearing exists but not primary event, cell changes seem to be primary driver of pain and pathology".
Complex pathology but key message is that = Tendons need load to maintain structure.
Treatment
Long term management. 3-6 months.
All about patient buy in and education, no chance without these.
Activity modification with slow progressive load management programme.
Consider impact on patient, potentially very limiting and damaging from a well being perspective.
Tests
Squeeze test for fracture.
Tinel's test for nerve.