Achilles' tendon tendinitis and heel pain

Benazzo, Francesco; Todesca, A.; Ceciliani, L.

doi:10.1016/s1060-1872(97)80040-8

Cited by 15 publications

(13 citation statements)

References 20 publications

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“…16,19,20 Some authors have even recommended removal of the entire paratenon. 2,21 However, as also stated previously by Kvist and Kvist, 7 we have observed that the adhesions are usually around the paratenon, attaching the paratenon to the inner aspect of the crural fascia. Based on our extensive experience in surgical treatment of Achilles tendon overuse injuries, we recommend that these adhesions be carefully trimmed away, leaving as many layers of the Achilles paratenon intact as possible.…”

Section: Discussionsupporting

confidence: 80%

“…The surgeon never used multiple longitudinal tendon incisions or socalled scarifications as recommended by some authors. 1,2,14 We believe this type of surgery unnecessarily diminishes the integrity of the tendon in the unaffected regions also. In the nine patients with an anomalous soleus muscle, the crural fascia was opened, the excessive and abnormally distally extending muscle mass excised, and, if needed, the tendon and the paratenon were freed from the adhesions.…”

Section: Surgical Techniquementioning

confidence: 99%

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Chronic Achilles Tendon Overuse Injury: Complications after Surgical Treatment

Orava²,

et al. 2000

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We analyzed the complications after surgical treatment of Achilles tendon overuse injuries in 432 consecutive patients. The patients underwent a clinical examination 2 weeks, and 1, 2, and 5 months after the surgery. If a complication appeared, the patient was followed up clinically for at least 1 year. There were 46 (11%) complications in the 432 patients: 14 skin edge necroses, 11 superficial wound infections, 5 seroma formations, 5 hematomas, 5 fibrotic reactions or scar formations, 4 sural nerve irritations, 1 new partial rupture, and 1 deep vein thrombosis. Fourteen patients with a complication had reoperations: four patients for skin edge necrosis, two for superficial wound infection, two for seroma formation, one for hematoma formation, two for fibrotic reaction or scar formation, two for sural nerve irritation, and one for a new partial rupture. About every 10th patient treated surgically for chronic Achilles tendon overuse injury suffered from a postoperative complication that clearly delayed recovery. However, the majority of patients with a complication healed and returned to their preinjury levels of activity. To reduce this morbidity, it is essential that the surgeon be continuously aware of the possibility of postoperative complications and use proper surgical techniques.

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Section: Discussionsupporting

confidence: 80%

Section: Surgical Techniquementioning

confidence: 99%

Chronic Achilles Tendon Overuse Injury: Complications after Surgical Treatment

Orava²,

et al. 2000

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“…Peritendonitis, also known as pertenonitis, presents with a fusiform swelling in the avascular region of the tendon, 68 due to inflammation and possible fibrotic adhesions between the endotenon and the peratenon 69,70 . This affliction is characterized by early morning pain, stiffness and crepitus, 68 due to the elastic behaviors of the tendon and apparent sheath retraction over the course of the night 71 .…”

Section: Diagnostic Interpretation and Managementmentioning

confidence: 99%

Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management

Sizer

Phelps²,

Dedrick

et al. 2003

Pain Practice

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Diagnosis, interpretation, and subsequent management of ankle/foot pathology can be challenging to clinicians. A sensitive and specific physical examination is the strategy of choice for diagnosing selected ankle/foot injuries and additional diagnostic procedures, at considerable cost, may not provide additional information for clinical diagnosis and management. Because of a distal location in the sclerotome and the reduced convergence of afferent signals from this region to the dorsal horn of the spinal cord, pain reference patterns are low and the localization of symptoms is trustworthy. Effective management of the painful ankle/foot is closely linked to a tissue-specific clinical examination. The examination of the ankle/foot should include passive and resistive tests that provide information regarding movement limitations and pain provocation. Special tests can augment the findings from the examination, suggesting compromises in the structural and functional integrity of the ankle/foot complex. The weight bearing function of the ankle/foot compounds the clinician's diagnostic picture, as limits and pain provocation are frequently produced only when the patient attempts to function in weight bearing. As a consequence, clinicians should consider this feature by implementing numerous weightbearing components in the diagnosis and management of ankle/foot afflictions. Limits in passive motion can be classified as either capsular or non-capsular patterns. Conversely, patients can present with ankle/foot pain that demonstrates no limitation of motion. Bursitis, tendopathy, compression neuropathy, and instability can produce ankle/foot pain that is challenging to diagnose, especially when they are the consequence of functional weight bearing. Numerous non-surgical measures can be implemented in treating the painful ankle/foot, reserving surgical interventions for those patients who are resistant to conservative care.

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“…This loose, highly elastic fibrillar tissue reduces friction during movement in context with the surrounding tissues 119 . Additionally, the paratenon can remain intact even during complete tendon rupture; while it is rarely involved in chronic tendinosis, 120 it is the primary source of affliction with periten‐dinitis, where the space can be filled with fibrotic adhesions 121–122 …”

Section: Locomotor Systemmentioning

confidence: 99%

Diagnosis and Management of the Painful Ankle/Foot Part 1: Clinical Anatomy and Pathomechanics

Sizer

Phelps²,

James

et al. 2003

Pain Practice

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Distinctive anatomical features can be witnessed in the ankle/foot complex, affording specific pathological conditions. Disorders of the ankle/foot complex are multifactoral and features in both the clinical anatomy and biomechanics contribute to the development of ankle/foot pain. The superior tibiofibular, distal tibiofibular, talocrural, subtalar, and midtarsal joint systems must all participate in function of the ankle/foot complex, as each biomechanically contributes to functional movements and clinical disorders witnessed in the lower extremity. A clinician's ability to effectively evaluate, diagnose, and treat the distal lower extremity is largely reliant upon a foundational understanding of the clinical anatomy and biomechanics of this complex complex. Thus, clinicians are encouraged to consider these distinctions when examining and diagnosing disorders of the ankle/foot.

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Achilles' tendon tendinitis and heel pain

Cited by 15 publications

References 20 publications

Chronic Achilles Tendon Overuse Injury: Complications after Surgical Treatment

Chronic Achilles Tendon Overuse Injury: Complications after Surgical Treatment

Diagnosis and Management of the Painful Ankle/Foot. Part 2: Examination, Interpretation, and Management

Diagnosis and Management of the Painful Ankle/Foot Part 1: Clinical Anatomy and Pathomechanics

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