Achilles tendon disorders

1. What is the mechanism of Achilles tendonitis/rupture?
2. What are the risk factors for Achilles injury?
3. How does Achilles tendonitis/rupture present?
4. What is the treatment of Achilles tendonitis?
5. What is the treatment of Achilles rupture?

Answers:
1. Tendonitis occurs by repetitive eccentric overload causing inflammation and microtears. Rupture occurs by sudden push-off with foot in extension position.
2. Hyperpronation, tight hamstrings and heel cords, pes cavus, genu varum, age, increase in mileage or intensity, change in footwear.
3. Tendonitis presents with posterior ankle pain, swelling, worse with push-off. Rupture presents with sudden audible snap with immediate swelling, ecchymosis and PF weakness, positive Thompson test.
4. Rest, ice, NSAIDs, short-term immobilization, stretching and strengthening, heel lifts, steroid injection near tendon.
5. Conservative treatment includes bracing in PF for 8-12 wks with gradual increase in activity. Surgery includes tendon repair with cast for 2 wks.