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Achilles Tendinopathy

Achilles Tendinopathy. “ “But I must have the confidence and I must be worthy of the great DiMaggio who does all things perfectly even with the pain of the bone spur ( Achilles) in his heel. ” Ernest Hemmingway, The Old Man and the Sea , 1952. Achilles Tendinopathy. Common

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Achilles Tendinopathy

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  1. Achilles Tendinopathy ““But I must have the confidence and I must be worthy of the great DiMaggio who does all things perfectly even with the pain of the bone spur ( Achilles) in his heel.” Ernest Hemmingway, The Old Man and the Sea, 1952

  2. Achilles Tendinopathy • Common • Difficult to treat • Slow to heal • Often recurrent • Requires treatment!

  3. At Risk Population • Athletes • Runners • Impact athletes • Sedentary • Excessive body weight

  4. Symptoms • Burning pain • Swelling • Stiffness • Nodule formation • Calcification or spur

  5. Two Types • Insertional (sedentary) • Pain at tendon/heel bone junction • Noninsertional (athletes) • Pain in the tendon, just above heel bone

  6. Nonoperative Treatment • Rest • Ice • Heel lift • Physical therapy • Stretching/strengthening • Immobilization

  7. Newer Treatment : Shock Wave Therapy • Safe • Effective • Noninvasive • In-office treatment • Popular in Europe/South America • Less available in USA

  8. Newer Treatment : Shock Wave Therapy • Enhancestendon healing • “Brings blood to tissue with poor blood supply”

  9. Injection Therapies • Platelet Rich Plasma ( PRP) • Works in animals • Controversial in humans • Expensive • Steroids…..Risky!! • Tendon ruptures

  10. Eccentric Strengthening • Done on a step • “Up on two/down on one” • Emphasize negative ( downward) phase

  11. Best Stretches-Two Types Bent Knee Straight Knee

  12. Surgical Options • Resect diseased tendon • Remove calcifications and spurs • Effective!! • BUT… • Requires immobilization • Slow recovery

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