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Achilles tendonitis; posterior tibial tendonitis

Etiology: (contributing factors) - in the elderly a) pes planus b) posterior tibial muscle weakness c) subtalar arthritis * Achilles' enthesitis in spondyloarthritis including Reiter's syndrome Pathology: - no inflammation on histopathology, thus a tendinopathy rather than tendonitis [2] Clinical manifestations: 1) burning heel pain & stiffness that worsens with activity & improves with rest [1] 2) symptoms generally occur after patient increases level of activity 3) chronic swelling along the Achilles tendon 4) maximal tenderness 4-5 cm proximal to the calcaneal insertion (range 2-6 cm), or as tender swelling at the point of insertion (insertional tendonitis) Management: 1) orthotics 2) Achilles tendon stretching exercises 3) glucocorticoid/local anesthetic injection a) inject into the retrocalcaneal bursa b) injection of the tendon itself may lead to rupture 4) high-volume saline injections of no benefit [4] 5) injection of platelet-rich plasma of no benefit [6]

Related

Achilles/calcaneal/heel tendon (chorda magna, tendo calcaneus) joint/bursa injection (knee injection, subacromial bursa injection) pes planus retrocalcaneal bursa; achilles bursa; bursa of calcaneal tendon

General

tendonitis (tendon injury)

References

  1. Clyman M. In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
  2. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015
  3. Roche AJ, Calder JD. Achilles tendinopathy: A review of the current concepts of treatment. Bone Joint J. 2013 Oct;95-B(10):1299-307. Review. PMID: 24078523
  4. van der Vlist AC et al Effectiveness of a high volume injection as treatment for chronic Achilles tendinopathy: randomised controlled trial. BMJ 2020;370:m3027 Not indexed in PubMed https://www.bmj.com/content/370/bmj.m3027
  5. van der Vlist AC, Winters M, Weir A et al Which treatment is most effective for patients with Achilles tendinopathy? A living systematic review with network meta-analysis of 29 randomised controlled trials. Br J Sports Med. 2020 Jun 10:bjsports-2019-101872. PMID: 32522732 Free article
  6. Kearney RS, Ji C, Warwick J et al. Effect of platelet-rich plasma injection vs sham injection on tendon dysfunction in patients with chronic midportion Achilles tendinopathy: A randomized clinical trial. JAMA 2021 Jul 13; 326:137 PMID: 34255009 https://jamanetwork.com/journals/jama/article-abstract/2781859