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Achilles disorders
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Maneesh Bhatia, Nicholas Eastley, Kartik Hariharan
A plain lateral radiograph is usually the first imaging modality performed (Figure 13.3). In addition, an ultrasound (US) or magnetic resonance image (MRI) scan is performed in most cases. MRI is particularly useful and can provide an important assessment of other potential causes of a patient's symptoms (such as retrocalcaneal bursitis or intraosseous pathologies) and quantifying the extent of any tendinopathy present (Figure 13.4). US performed by an experienced radiologist offers excellent visualisation of the structures around the insertion of AT, and a good means to assess tenosynovitis and vascularity – both indicators of the activity of the degenerative process. It is also especially useful for US guided therapeutic intervention.
Surgery of the Ankle
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Matthew Welck, Laurence James, Dishan Singh
There are three common patterns of Achilles tendon pathology: Partial and complete ruptures: There is a sudden onset of severe pain and marked disability. These ruptures are 10 times more common in males, with peak incidence in the 30s and 40s. Patients often describe hearing a ‘pop’ and feel an impact in the back of the leg or heel.Non-insertional (mid-substance) tendinopathy: This often has a gradual onset, classically with morning pain and stiffness that eases with activity and reoccurs at rest later. Associated with a sudden increase in activity, change of surface or change of footwear/poor footwear.Insertional tendinopathy: Degeneration and inflammation at the insertion of the Achilles tendon onto the calcaneus. This can be accompanied by a number of pathologies including retrocalcaneal bursitis, Haglund's disease (painful retrocalcaneal bursitis and a bony prominence), Achilles bursitis and enthesopathy.
The ankle and foot
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Calcaneal bursitis Older girls and young women often complain of painful bumps on the backs of their heels. The posterolateral portion of the calcaneum is prominent and shoe friction causes retrocalcaneal bursitis. Symptoms are worse in cold weather and when wearing high-heeled shoes (hence the use of colloquial labels such as ‘winter heels’ and ‘pumpbumps’). Treatment should be conservative – attention to footwear (open-back shoes are best) and padding of the heel. Operative treatment – removal of the bump or dorsal wedge osteotomy of the calcaneum – is feasible but the results are unpredictable; despite the reduction in the size of the bumps, patients often continue to experience discomfort, potentially added to by an operation scar.
Mid-term results of hindfoot arthrodesis with a retrograde intramedullary nail in 24 patients with diabetic Charcot neuroarthropathy
Published in Acta Orthopaedica, 2020
Mehmet Ersin, Mehmet Demirel, Mehmet Chodza, Fuat Bilgili, Onder Ismet Kiliçoglu
The demographic data and preoperative comorbidities of all the patients are summarized in the Table. Radiographic solid fusion was obtained with retrograde intramedullary nailing in 23 of 24 patients (Figure 2 and 3), with an average time to fusion of 10 months (6–14). In the remaining patient who underwent tibiotalocalcaneal arthrodesis there was no radiographic evidence of solid fusion at follow-up, but revision was not considered because the patient remained asymptomatic. All the patients were able to bear weight on the affected foot with or without support; physical examination revealed no recurrent deformity. No patient underwent amputation. During postoperative follow-up, four patients with superficial infection (4/24) were treated successfully with antibiotic and local debridement; none of the patients developed deep soft tissue infection or osteomyelitis. In addition, there was no need for revision surgery; however, the spiral blade in 1 patient and the calcaneal locking screw in 2 patients were removed due to retrocalcaneal bursitis.
Cross-cultural adaptation, reliability and validity of the Persian version of the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A)
Published in Disability and Rehabilitation, 2022
Milad Bahari, Mohammad Hadadi, Amir Reza Vosoughi, Amin Kordi Yoosefinejad, Sobhan Sobhani
Inclusion criteria were as follows: individuals aged over 18 years and able to read and write in Persian with the diagnosis of unilateral mid-portion or insertional Achilles tendinopathy, paratendinosis, partial tendon rupture with or without retrocalcaneal bursitis. Patients with a complete rupture of Achilles tendon, pregnant women and those with any history of radicular pain or lower extremity injury or previous surgery were excluded from the study [21].