Database: MEDLINE <1966 to May Week 4 2002>
Search Strategy: (Plantar fasciitis and other heel injuries)
------------------------------------------------------------------------------1
exp Fasciitis/ (2145)
2
plantar.af. and 1 (171)
3
Achilles Tendon/in [Injuries] (1087)
4
Heel/in [Injuries] (155)
5
2 or 3 or 4 (1400)
6
limit 5 to (human and english language) (846)
7
exp sports/ or exp athletic injuries/ (49186)
8
6 and 7 (230)
9
limit 8 to review articles (40)
10
limit 8 to yr=1996-2002 (81)
11
9 and 10 (15)
12
exp *Fasciitis/ or *Achilles Tendon/in or *Heel/in (2684)
13
10 and 12 (66)
14
11 or 13 (71)
15
limit 13 to yr=1998-2002 (49)
16
11 or 15 (56)
17
et.fs. and 10 (32)
18
17 not 16 (11)
19
16 or 17 (67)
20
limit 19 to yr=1998-2002 (57)
21
from 20 keep 1-57 (57)
***************************
<1>
Unique Identifier
10743996
Medline Identifier
20205863
Authors
Nestorson J. Movin T. Moller M. Karlsson J.
Institution
Department of Orthopaedics, Huddinge University Hospital, Sweden.
Title
Function after Achilles tendon rupture in the elderly: 25 patients
older than 65 years followed for 3 years.
Source
Acta Orthopaedica Scandinavica. 71(1):64-8, 2000 Feb.
Abstract
We retrospectively analyzed the function after Achilles tendon rupture
in 25 patients older than 65 years, 3 (1-5) years after the initial
treatment. The patients' median age at the time of injury was 71 (65-86)
years. The initial management was surgical in 14 patients and nonsurgical (8-week immobilization) in 10, 1 patient was not treated. The
ratio of the number of heel-raises on the injured to the uninjured side
was median 0.64 (0-1.14), showing a reduction in performance. However, in
both surgically- and non-surgically-treated patients, the subjective
impairment was mild, and the patients were able to perform most walking
activities. Only 9 patients reached their previous activity level. Comorbidity was frequent: 17 patients had other diseases that affected
their performance. 14 complications occurred in 11 patients. 5 patients
sustained a rerupture (4 following initial closed treatment with
plaster), 1 a deep venous thrombosis and 4 had superficial infections
requiring antibiotic treatment. 1 patient sustained a fibular nerve
injury following compression by the plaster cast and another a sural
nerve injury during the operation. 2 patients had symptoms due to
adhesions between the tendon and the skin. We conclude that Achilles
tendon rupture in patients older than 65 years reduces lower limb
function and that complications are common following surgical and nonsurgical treatment.
<2>
Unique Identifier
10882283
Medline Identifier
20338131
Authors
Karjalainen PT. Soila K. Aronen HJ. Pihlajamaki HK. Tynninen O.
Paavonen T. Tirman PF.
Institution
Department of Radiology, Helsinki University Central Hospital, Finland.
Title
MR imaging of overuse injuries of the Achilles tendon.
Source
AJR. American Journal of Roentgenology. 175(1):251-60, 2000 Jul.
Abstract
OBJECTIVE: This study was conducted to illustrate and classify the
abnormalities found on high-resolution MR imaging of symptomatic Achilles
tendons in athletic adult patients. SUBJECTS AND METHODS: One hundred
patients with 118 painful Achilles tendons were imaged with a 1.5-T
magnet. The tendon, peritendinous tissues, tendon insertion, and
musculotendinous junction were examined on MR imaging. Twenty-eight
patients underwent surgery, and histopathologic samples were taken in 13.
Long-term follow-up was performed, on average, 3.4 years after MR
imaging. RESULTS: Of 118 painful Achilles tendons, abnormalities were
detected in 111. These were in the tendon (n = 90), surrounding
structures, or both. Fifty-four tendons had a focal area of increased
intratendinous signal, best detected on axial high-resolution T1-weighted
gradient-echo MR imaging. Histopathology confirmed abnormal tendon
structure. Of the 21 surgically proven foci of tendinosis, 20 were
revealed on MR imaging. At the level of the insertion, changes were found
in the tendon in 15%, in the retrocalcaneal bursa in 19%, and in the
calcaneal bone marrow in 8% of the studies. Abnormalities in
peritendinous soft tissues were detected in 67%. More than one type of
abnormality was found in 64% of the studies. CONCLUSION: Lesions in the
Achilles tendon and in the peritendinous structures can have similar
clinical presentation. MR imaging detects and characterizes these
changes. A more specific diagnosis and prognosis can be made with the use
of MR imaging than with clinical examination alone.
<3>
Unique Identifier
9617396
Medline Identifier
98280390
Authors
Alfredson H. Pietila T. Jonsson P. Lorentzon R.
Institution
Department of Orthopaedic Surgery, University Hospital of Northern
Sweden, Umea, Sweden.
Title
Heavy-load eccentric calf muscle training for the treatment of chronic
Achilles tendinosis.
Source
American Journal of Sports Medicine. 26(3):360-6, 1998 May-Jun.
Abstract
We prospectively studied the effect of heavy-load eccentric calf muscle
training in 15 recreational athletes (12 men and 3 women; mean age, 44.3
+/- 7.0 years) who had the diagnosis of chronic Achilles tendinosis
(degenerative changes) with a long duration of symptoms despite
conventional nonsurgical treatment. Calf muscle strength and the amount
of pain during activity (recorded on a visual analog scale) were measured
before onset of training and after 12 weeks of eccentric training. At
week 0, all patients had Achilles tendon pain not allowing running
activity, and there was significantly lower eccentric and concentric calf
muscle strength on the injured compared with the noninjured side. After
the 12-week training period, all 15 patients were back at their preinjury
levels with full running activity. There was a significant decrease in
pain during activity, and the calf muscle strength on the injured side
had increased significantly and did not differ significantly from that of
the noninjured side. A comparison group of 15 recreational athletes with
the same diagnosis and a long duration of symptoms had been treated
conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes
of shoes or orthoses, physical therapy, and in all cases also with
ordinary training programs. In no case was the conventional treatment
successful, and all patients were ultimately treated surgically. Our
treatment model with heavy-load eccentric calf muscle training has a very
good short-term effect on athletes in their early forties.
<4>
Unique Identifier
9617415
Medline Identifier
98280409
Authors
Fahlstrom M. Bjornstig U. Lorentzon R.
Institution
Rehabilitation Medicine Clinic, University Hospital of Umea, Sweden.
Title
Acute Achilles tendon rupture in badminton players.
Source
American Journal of Sports Medicine. 26(3):467-70, 1998 May-Jun.
Abstract
All patients with badminton-related acute Achilles tendon ruptures
registered during 1990 to 1994 at the University Hospital of Umea were
retrospectively followed up using a questionnaire. Thirty-one patients
(mean age, 36.0 years), 27 men and 4 women, were included. Thirty
patients (97%) described themselves as recreational players or beginners.
The majority of the injuries (29 of 31, 94%) happened at the middle or
end of the planned game. Previous local symptoms had been noticed by five
patients (16%). Long-term results showed that patients treated with
surgery had a significantly shorter sick leave absence than patients
treated without surgery (50 versus 75 days). There was no obvious
selection favoring any treatment modality. None of the surgically treated
patients had reruptures, but two reruptures occurred in the nonsurgically
treated group. There seemed to be fewer remaining symptoms and a higher
sports activity level after the injury in the surgically treated group.
Our results indicate that local muscle fatigue may interfere with
strength and coordination. Preventive measures such as specific treatment
of minor injuries and adequate training of strength, endurance, and
coordination are important. Our findings also indicate that surgical
treatment and careful postoperative rehabilitation is of great importance
among badminton players of any age or sports level with Achilles tendon
rupture.
<5>
Unique Identifier
9850780
Medline Identifier
99067766
Authors
Speck M. Klaue K.
Institution
Department of Orthopaedic Surgery, University of Berne, Inselspital,
Switzerland.
Title
Early full weightbearing and functional treatment after surgical repair
of acute achilles tendon rupture.
Source
American Journal of Sports Medicine. 26(6):789-93, 1998 Nov-Dec.
Abstract
We prospectively evaluated the clinical outcomes of 20 patients (mean
age, 42.8 years) with early full weightbearing and functional treatment
after surgical repair of acute Achilles tendon rupture according to a
prospective intra- and postoperative protocol. All patients underwent
open repair using a Kessler-type suture and simple apposition sutures.
The postoperative regimen included a plantigrade splint for 24 hours and
6 weeks of early full weightbearing in a removable walker. All patients
were evaluated with clinical and ultrasound examination and according to
a new scoring system at 3, 6, and 12 months after repair. After 3 months,
the score averaged 73 of 100 points; after 6 months, 86; and after 1
year, 94. All patients reached the same level of sports activities as
preoperatively and demonstrated no significant difference in ankle
mobility and isokinetic strength. There were no reruptures. One patient
had a deep venous thrombosis 3 weeks after the operation after having
prematurely stopped thromboprophylaxis. We believe that early careful
ankle mobilization and full weightbearing in a removable walker after
primary Achilles tendon repair does not increase the risk of rerupture.
An accelerated rehabilitation program improves early foot function with
excellent recovery of plantar flexion strength and amplitude.
<6>
Unique Identifier
9850781
Medline Identifier
99067767
Authors
Aoki M. Ogiwara N. Ohta T. Nabeta Y.
Institution
Department of Orthopaedic Surgery, Sapporo Medical University, Japan.
Title
Early active motion and weightbearing after cross-stitch achilles
tendon repair.
Source
American Journal of Sports Medicine. 26(6):794-800, 1998 Nov-Dec.
Abstract
Twenty-two closed Achilles tendon ruptures caused by sports injuries in
22 patients (average age, 37.6 years) were repaired with Kirschmayer core
suture and cross-stitch epitenon suture, and early active ankle motion
with weightbearing was implemented after surgery. This study was
undertaken to evaluate the effectiveness of the repair technique and
rehabilitation protocol by assessing clinical results and magnetic
resonance imaging findings. The follow-up period averaged 24.6 months.
Twenty of the tendons (91%) healed without rerupture, and two tendons
(9%) suffered a partial rerupture at 23 and 56 days, respectively. Active
ankle extension reached from the minus range to 0 degree in an average of
9.7 days, and ankle motion recovered to normal in an average of 6.0
weeks. Full weightbearing without heel raising became possible in an
average of 16.4 days, and heel raising with both legs became possible in
an average of 7.3 weeks. The patients returned to full sports activity in
13.1 weeks. The interval until the area of high-intensity signal at the
tendon repair site on T2-weighted magnetic resonance imaging scans became
intermediate-intensity signal averaged 6.9 weeks, and the tendon repair
site became low-intensity signal in an average of 12.6 weeks,
demonstrating excellent tendon healing. Treatment employing Kirschmayer
core suture and cross-stitch epitenon suture may help athletes return to
sports activity in a shorter period than that allowed by previous methods
of repair for Achilles tendon ruptures.
<7>
Unique Identifier
11798996
Medline Identifier
21656892
Authors
Fahlstrom M. Lorentzon R. Alfredson H.
Institution
Department of Surgical and Perioperative Sciences, Sports Medicine,
National Institute for Working Life, University Hospital of Umea, Umea,
Sweden.
Title
Painful conditions in the Achilles tendon region in elite badminton
players.
Source
American Journal of Sports Medicine. 30(1):51-4, 2002 Jan-Feb.
Abstract
The purpose of this study was to investigate the prevalence and
characteristics of painful conditions in the Achilles tendon region in
elite badminton players. The study group consisted of 66 players in the
Swedish elite division (highest level) in badminton, 41 men (mean age,
24.4 years) and 25 women (mean age, 21.9 years). Twenty-one players (32%)
reported the occurrence of a disabling painful condition in the Achilles
tendon region during the previous 5 years, and 11 players (17%) had an
ongoing painful condition. A majority of the painful conditions (12 of
21, or 57%) were described as involving the midportion of the Achilles
tendon. The players who had a painful condition reported a significantly
higher weekly training load as measured by the number of hours spent in
total training, badminton training, and endurance and strength training.
There were no differences in age, sex, and body mass index between the
players with and without painful conditions in the Achilles tendon
region.
<8>
Unique Identifier
10653548
Medline Identifier
20117273
Authors
Paavola M. Orava S. Leppilahti J. Kannus P. Jarvinen M.
Institution
Department of Surgery, Tampere University Hospital, Finland.
Title
Chronic Achilles tendon overuse injury: complications after surgical
treatment. An analysis of 432 consecutive patients.
Source
American Journal of Sports Medicine. 28(1):77-82, 2000 Jan-Feb.
Abstract
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.
<9>
Unique Identifier
11394603
Medline Identifier
21287815
Authors
Bressel E. McNair PJ.
Institution
School of Physiotherapy, Auckland University of Technology, New
Zealand.
Title
Biomechanical behavior of the plantar flexor muscle-tendon unit after
an Achilles tendon rupture.
Source
American Journal of Sports Medicine. 29(3):321-6, 2001 May-Jun.
Abstract
The purpose of this study was to examine the biomechanical behavior of
the plantar flexor muscle-tendon unit in subjects who had ruptured their
Achilles tendon. Twenty-six men and 14 women volunteered for the study.
Eighteen subjects had been treated operatively and 22, nonoperatively.
All subjects had ruptured their Achilles tendon more than 1 year before
the study, and 28 of the 40 ruptures occurred 5 years or less before the
day of testing. A KinCom dynamometer was used to measure ankle joint
angle, passive torque, and maximal isometric plantar flexor torque.
During a 2-minute passive calf stretch, stiffness and torque relaxation
were calculated. Isometric torque and peak passive torque were 17% and
10% greater for the uninvolved versus the involved limb, whereas
stiffness and torque relaxation were not different between limbs. The
time since injury did not influence the results, nor did the mode of
initial treatment, that is, whether the subjects were treated operatively
or nonoperatively. These findings suggest that changes in strength and
peak passive torque may be chronic adaptations associated with Achilles
tendon rupture.
<10>
Unique Identifier
10791646
Medline Identifier
20250285
Authors
Nyyssonen T. Luthje P.
Institution
Department of Surgery, Kuusankoski District Hospital, Finland.
timo.nyyssonen@tiny.pp.fi
Title
Achilles tendon ruptures in South-East Finland between 1986-1996, with
special reference to epidemiology, complications of surgery and hospital
costs.
Source
Annales Chirurgiae et Gynaecologiae. 89(1):53-7, 2000.
Abstract
BACKGROUND AND AIMS: The incidence of achilles tendon (AT) ruptures is
increasing. The aim of the present study was to evaluate annual
incidence, aetiology, operative complications and direct hospital costs
of AT ruptures. MATERIAL AND METHODS: A retrospective study of 93
consecutive patients operated on for AT rupture from January 1986 to
December 1996 at Kuusankoski District Hospital (area with 92,500
inhabitants) was performed. During the observation period no patient with
an AT rupture was treated conservatively. RESULTS: 95 AT ruptures were
treated including one rerupture (1%) and one patient with two ruptures.
There were 7 (7%) patients with an open AT rupture. The total annual
incidence in the hospital area was 8.6 (+/- 4.3) and for closed AT
ruptures 8.0 (+/- 3.8). The total incidence was 9.3 (+/- 4.6)/10(5) and
for closed AT ruptures 8.6 (+/- 4.1)/10(5) inhabitants per year. Most of
the injuries were sport related, the most frequent sport being
volleyball. Patients operated for closed AT rupture had major surgical
complications in 4.5% of the cases and the total complication rate was
11%. The average direct hospital costs per patient was USD 1375.
CONCLUSIONS: The incidence of AT ruptures is increasing in South-East
Finland. The rate of major surgical complication was low (4.5%) and
comparable with earlier studies.
<11>
Unique Identifier
9709852
Medline Identifier
98375617
Authors
Winter E. Weise K. Weller S. Ambacher T.
Institution
Berufsgenossenschaftliche Unfallklinik, Tubingen, Germany.
Title
Surgical repair of Achilles tendon rupture. Comparison of surgical with
conservative treatment.
Source
Archives of Orthopaedic & Trauma Surgery. 117(6-7):364-7, 1998.
Abstract
Achilles tendon suture combined with a triceps surae tendon tip-over
graft was performed in 314 patients with acute rupture of the Achilles
tendon between 1980 and 1991. Analysis of these cases showed a low tissue
complication rate compared with that reported in the literature. An
average of 8.1 years after repair, 223 patients were examined using
Holz's scale of clinical assessment after Achilles tendon repair. The
results were 'good' in 87.4%, 'fair' in 11.2% and 'poor' in 1.4%. The rerupture rate was very low (0.4%). These results are better than the rerupture rate after surgical repair with solely end-to-end suture or after
conservative immobilizing or conservative functional treatment. In
conclusion, these data show that the fascial reinforcement is a valuable
complement to the tendon suture.
<12>
Unique Identifier
11880912
Medline Identifier
21868611
Authors
Kerkhoffs GM. Struijs PA. Raaymakers EL. Marti RK.
Institution
Department of Orthopaedic Surgery, Academic Medical Center, University
of Amsterdam, PO Box 22700, 1105 AZ Amsterdam, The Netherlands.
ginokerkhoffs@hotmail.com
Title
Functional treatment after surgical repair of acute Achilles tendon
rupture: wrap vs walking cast.
Source
Archives of Orthopaedic & Trauma Surgery. 122(2):102-5, 2002 Mar.
Abstract
The aim of this study was to compare the clinical outcome for patients
treated with walking cast immobilization and wrap early mobilization
after surgical repair of acute Achilles tendon ruptures. A total of 39
consecutive patients with complete ruptures of the Achilles tendon were
identified, treated, and functionally rehabilitated with either a walking
cast or a wrap. Because the randomization was quasi-random, chi-square
and t-tests were performed to compare the baseline characteristics. A
statistically significant difference was present only for the injured
side ( p<0.05). Therefore, groups were considered comparable for analysis
of outcome. All patients were evaluated at an average follow-up of 6.7
years (range 5-8 years). Functional postoperative treatment with a wrap
allowed a significantly shorter hospital stay ( p<0.05) as well as a
shorter period to return to pre-injury sports level ( p<0.01) compared
with treatment with a walking cast. According to the modified Rupp score,
91.3% of patients in the walking cast group had a good or excellent
result, as did 93.8% in the wrap group ( p=0.9). Slight atrophy of the
calf muscles was reported in 3 patients in the walking cast group (13.0%)
and in 4 in the wrap group (25.0%). One re-rupture was reported in the
walking cast group (4.3%). Functional treatment after surgical Achilles
tendon repair is safe, and there is no increased risk of re-rupture or
wound healing problems. Functional treatment with a wrap is preferable to
treatment with a walking cast with respect to hospitalization time and
return to sports.
<13>
Unique Identifier
10721541
Medline Identifier
20186319
Authors
Brukner P.
Institution
Olympic Park Sports Medicine Centre, Melbourne, Victoria.
Title
Calf and ankle swelling.
Source
Australian Family Physician. 29(1):35-40, 2000 Jan.
Abstract
BACKGROUND: Swelling of the calf and ankle region is a common
presenting symptom and historical features such as speed of onset, trauma
and mechanism of injury are important in aiding diagnosis. OBJECTIVE: To
discuss diagnosis and management of musculoskeletal causes of calf and
ankle swelling. DISCUSSION: Calf muscle injuries and injuries around the
ankle including Achilles tendon injuries, ankle ligament injuries and
overuse injuries are discussed.
<14>
Unique Identifier
9735493
Medline Identifier
98406454
Authors
Baquie P.
Institution
Albert Park and Olympic Park Sports Medicine Centres, Melbourne.
Title
Golfer's heel.
Source
Australian Family Physician. 27(8):727-8, 1998 Aug.
<15>
Unique Identifier
10690457
Medline Identifier
20155047
Authors
Khan K. Kannus P.
Title
Use of imaging data for predicting clinical outcome. [see comments.].
Comments
Comment in: Br J Sports Med. 2000 Aug;34(4):315 ; 10953911
Source
British Journal of Sports Medicine. 34(1):73, 2000 Feb.
<16>
Unique Identifier
11273977
Medline Identifier
21172309
Authors
Fletcher MD. Warren PJ.
Institution
Department of Orthopaedic Surgery, Northwick Park Hospital, Watford
Road, Harrow, Middx HA1 3UJ, UK. matt.fletcher@doctors.org.uk
Title
Sural nerve injury associated with neglected tendo Achilles ruptures.
Source
British Journal of Sports Medicine. 35(2):131-2, 2001 Apr.
Abstract
Two patients are described with delayed presentation of a ruptured
tendo Achilles, each exhibiting signs of sural nerve dysfunction.
Recovery occurred in each case after operative repair.
<17>
Unique Identifier
11126717
Medline Identifier
21003029
Authors
Martinelli B.
Institution
Department of Orthopaedic Surgery, Ospedale Maggiore, University of
Trieste, Italy.
Title
Percutaneous repair of the Achilles tendon in athletes.
Source
Bulletin of the Hospital for Joint Diseases. 59(3):149-52, 2000.
Abstract
The rupture of the Achilles tendon during amateur or professional
sport-related activities is becoming more frequent, as is the request for
treatments that enable the fastest possible recovery. This study includes
30 patients who sustained rupture of the Achilles tendon during various
sport activities; for the last five years we have performed percutaneous
suture repair by means of two parallel Dacron threads equipped with a
harpoon and a malleable needle. This method alone enables immediate
mobilization and an early load, preserves the blood supply of the
paratenon, benefits from the motion which accelerates repair, without the
well known complications produced both by the non-operative and by open
surgical treatments. Excellent results have been achieved and all
patients returned to their pre-injury level of sports activity after 120
to 150 days.
<18>
Unique Identifier
10203422
Medline Identifier
99219827
Authors
Alfredson H. Nordstrom P. Pietila T. Lorentzon R.
Institution
Sports Medicine Unit, University of Umea, S-90185, Umea, Sweden.
Title
Bone mass in the calcaneus after heavy loaded eccentric calf-muscle
training in recreational athletes with chronic achilles tendinosis.
Source
Calcified Tissue International. 64(5):450-5, 1999 May.
Abstract
In an ongoing prospective study of 14 recreational athletes (12 males
and 2 females, mean age 44.2 +/- 7.1 years) with unilateral chronic
Achilles tendinosis, we investigated the effect of treatment with heavyloaded eccentric calf-muscle training. Pain during activity (recorded on
a VAS scale) and isokinetic concentric and eccentric calf-muscle strength
(peak torque at 90 degrees /second and 225 degrees /second) on the
injured and noninjured side were evaluated. In this group of patients, we
examined areal bone mineral density (BMD) of the calcaneus after 9 months
(range 6-14 months) of training. BMD of the injured side (subjected to
heavy-loaded eccentric training) was compared with BMD of the noninjured
side. Before onset of heavy-loaded eccentric training, all patients had
Achilles tendon pain which prohibited running activity, and significantly
lower concentric and eccentric plantar flexion peak torque on the injured
compared with the noninjured side. The training program consisted of 12
weeks of daily, heavy-loaded, eccentric calf-muscle training; thereafter
the training was continued for 2-3 days/week. The clinical results were
excellent-all 14 patients were back at their preinjury level with full
running activity at the 3 month follow-up. The concentric and eccentric
plantar flexion peak torque had increased significantly and did not
significantly differ from the noninjured side at the 3 and 9 month
follow-up. There were no significant side-to-side differences in BMD of
the calcaneus. There was no significant relationship between BMD of the
calcaneus and calf-muscle strength. As a comparison group, we used 10
recreational athletes (5 males and 5 females) mean age 40.9 years (range
26-55 years), who were selected for surgical treatment of chronic
Achilles tendinosis localized at the 2-6 cm level. Their duration of
symptoms and severity of disease were the same as in the experimental
group. There were no significant side-to-side differences in BMD of the
calcaneus preoperatively, but 12 months postoperatively BMD of the
calcaneus was 16.4% lower at the injured side compared with the
noninjured side. Heavy-loaded eccentric calf-muscle training resulted in
a fast recovery in all patients, equaled the side-to-side differences in
muscle strength, and was not associated with side-to-side differences in
BMD of the calcaneus. In this group of middle-aged recreational athletes,
BMD of the calcaneus was not related to calf-muscle strength.
<19>
Unique Identifier
11733128
Medline Identifier
21590272
Authors
Rome K. Webb P. Unsworth A. Haslock I.
Institution
Rehabilitation Research Unit, School of Health, University of Teesside,
TS1 3BA, Middlesbrough, UK. k.rome@tees.ac.uk
Title
Heel pad stiffness in runners with plantar heel pain.
Source
Clinical Biomechanics. 16(10):901-5, 2001 Dec.
Abstract
OBJECTIVE: To evaluate significant differences in heel pad stiffness
within a cohort of runners with diagnosed plantar heel pain and to
explore the clinical importance of maximum heel pad stiffness values.
DESIGN: A cross-sectional design was used to quantify the heel pad
stiffness of 166 runners with 33 diagnosed with plantar heel pain.
BACKGROUND: Palpation is still widely used to evaluate heel pad stiffness
subjectively in everyday clinical practice. However, there is limited
quantifiable data pertaining to heel pad stiffness measurements in
runners and those with heel pain. METHODS: A portable hand-held device
measured force applied by a metal probe, and its displacement into the
plantar surface of the heel pad. Non-linear modelling allowed curve
coefficients b0 and b1 to be evaluated and was described by an
exponential function using a non-linear regression equation. Exploratory
analysis was used to describe a single-point approximation for clinical
use. RESULTS: An independent t-test demonstrated a statistically
significant difference between the curve coefficient b1 (p<0.05). No
significant difference was found for coefficient b0 between the plantar
heel pain group and the non-plantar heel pain group (p>0.05). Exploratory
analysis demonstrated maximum mean stiffness of 3.22 N/mm for the nonplantar heel pain group and 2.87 N/mm for the plantar heel pain-group, an
11% mean difference. CONCLUSION: The results suggested that heel pad
stiffness may be associated with plantar heel pain subjects. RELEVANCE:
Heel pad stiffness measurements may give a better insight into the
mechanical properties of the heel pad in subjects with plantar heel pain.
<20>
Unique Identifier
11086753
Medline Identifier
20537588
Authors
Maffulli N. Reaper JA. Waterston SW. Ahya T.
Institution
Department of Orthopaedic Surgery, University of Aberdeen Medical
School, Scotland, UK.
Title
ABO blood groups and achilles tendon rupture in the Grampian Region of
Scotland.
Source
Clinical Journal of Sport Medicine. 10(4):269-71, 2000 Oct.
Abstract
OBJECTIVE: To test whether the association between blood groups and
Achilles tendon rupture (ATR) reported in some Scandinavian countries and
in Hungary was present in our region. METHODS: We studied 78 patients
treated at Aberdeen Royal Infirmary from 1990 to 1996, and compared their
distribution of ABO blood groups with that found in 24.501 blood donors
typed at the Blood Transfusion Centre during the same period. RESULTS:
Overall, 47 of 78 (60%) of patients with an Achilles tendon rupture
belonged to blood group O, compared with 51% of the population as a
whole. Only 22 (28%) of the Achilles tendon rupture patients belonged to
blood group A, whereas 35% of the general population were members of this
group (NS). The A/O ratio was 0.47 for the tendon rupture patients,
compared with 0.68 for the general population (NS). CONCLUSIONS: We could
not demonstrate any significant association between the proportions of
ABO blood groups and ATR in the Grampian Region of Scotland. The findings
in other studies could be due to peculiarities in the distribution of the
ABO groups in genetically segregated populations.
<21>
Unique Identifier
11403110
Medline Identifier
21295740
Authors
Fredericson M. Standage S. Chou L. Matheson G.
Institution
Department of Functional Restoration, Stanford University Medical
Center, California, USA.
Title
Lateral plantar nerve entrapment in a competitive gymnast.
Source
Clinical Journal of Sport Medicine. 11(2):111-4, 2001 Apr.
<22>
Unique Identifier
11417154
Medline Identifier
21310827
Authors
Tomczak RL.
Institution
Department of Orthopaedics, Ohio State University Medical Center,
Columbus, Ohio, USA.
Title
Surgery of the Achilles' tendon. [Review] [34 refs]
Source
Clinics in Podiatric Medicine & Surgery. 18(2):255-71, vi, 2001 Apr.
Abstract
Without question, injury to the Achilles' tendon is one of the
commonest running injuries involving the lower extremity. Repair of acute
and delayed ruptures is discussed. Tendonitis is by far commoner than
ruptures. The pathology and conservative and surgical treatments are
discussed. [References: 34]
<23>
Unique Identifier
11417153
Medline Identifier
21310826
Authors
Humble RN. Nugent LL.
Institution
Division of Podiatric Surgery, Department of Surgery, Faculty of
Medicine, University of Calgary, Calgary, Alberta, Canada.
humble@alberta-podiatry.ab.ca
Title
Achilles' tendonitis. An overview and reconditioning model. [Review]
[43 refs]
Source
Clinics in Podiatric Medicine & Surgery. 18(2):233-54, 2001 Apr.
Abstract
Achilles' tendon injuries are common in runners. The muscle tendon
complex primarily functions eccentrically, and it is during this phase
that failure occurs. Reconditioning programs that incorporate eccentric
strengthening and plyometric and other neuromuscular strengthening
theories with a concerted specific gradual activity challenge can be
successful. To optimize return to activity, more work needs to be done to
identify the amount of stress (i.e., exercise) that can be tolerated at a
specific phase of the inflammatory process. [References: 43]
<24>
Unique Identifier
11224740
Medline Identifier
21124480
Authors
Jarvinen TA. Kannus P. Paavola M. Jarvinen TL. Jozsa L. Jarvinen
M.
Institution
Institute of Medical Technology and Medical School, University of
Tampere, Tampere, Finland.
Title
Achilles tendon injuries. [Review] [31 refs]
Source
Current Opinion in Rheumatology. 13(2):150-5, 2001 Mar.
Abstract
The Achilles tendon is the strongest tendon in the human body. Because
most Achilles tendon injuries take place in sports and there has been an
common upsurge in sporting activities, the number and incidence of the
Achilles tendon overuse injuries and complete ruptures have increased in
the industrialized countries during the last decades. The most common
clinical diagnosis of Achilles overuse injuries is tendinopathy, which is
characterized by a combination of pain and swelling in the Achilles
tendon accompanied by impaired ability to perform strenuous activities.
Most patients with Achilles tendon injury respond favorably to
conservative treatment and only those who fail to respond to carefully
followed nonoperative treatment should undergo surgery for repair. A
complete rupture of the Achilles tendon usually occurs in sports that
require jumping, running, and quick turns. Although histopathologic
studies have shown that ruptured Achilles tendons include clear
degenerative changes before the rupture, many of the Achilles tendon
ruptures occur suddenly without any preceding signs or symptoms. Neither
conservative nor operative treatment is a treatment of choice for the
ruptured Achilles tendon. It is generally accepted that surgery should be
performed on ruptured Achilles tendons in young, physically active
patients and in those patients for whom the diagnosis or the treatment of
the rupture has been delayed, whereas the results of conservative
treatment are an acceptable outcome in older patients with sedentary
lifestyles. Many important issues still remain unanswered concerning the
cause, pathogenesis, diagnosis, and management of the Achilles tendon
disorders. Only when these issues have been solved by well-controlled
studies can tailored treatment protocols be created. [References: 31]
<25>
Unique Identifier
11224739
Medline Identifier
21124479
Authors
Biundo JJ Jr. Irwin RW. Umpierre E.
Institution
Louisiana State University Health Sciences Center, Department of
Medicine, Section of Physical Medicine and Rehabilitation, New Orleans,
Louisiana 70112, USA. pmr@lsuhsc.edu
Title
Sports and other soft tissue injuries, tendinitis, bursitis, and
occupation-related syndromes. [Review] [17 refs]
Source
Current Opinion in Rheumatology. 13(2):146-9, 2001 Mar.
Abstract
Three topics are reviewed: iliopsoas bursitis (IPB), iliotibial band
frictional syndrome (ITBFS), and Achilles tendinopathy. Although not
frequently diagnosed, IPB may be more prevalent than what is commonly
thought. Several excellent review articles are presented. Imaging studies
are usually needed for confirmation of the diagnosis, and a report on
magnetic resonance imaging is presented. Successful treatment of IPB with
home exercise is reviewed. Because an increasing number of people are
exercising, there is an increasing need to know the syndromes that can
result from overuse, such as ITBFS. Several articles on the use of
diagnostic ultrasonography and magnetic resonance imaging to aid in the
confirmation of this entity are reviewed; one article explores the
pathology of ITBFS in a cadaveric study. In the section of the treatment
of ITBFS the authors review one article on exercise and one on surgery.
Use of ultrasound to aid in the diagnosis of Achilles tendinopathy is
reviewed, as well as risk factors related to developing it. Two articles
on surgical treatment are reviewed. [References: 17]
<26>
Unique Identifier
9542986
Medline Identifier
98201985
Authors
Bedi HS. Love BR.
Institution
Geelong Hospital, Victoria, Australia.
Title
Differences in impulse distribution in patients with plantar fasciitis.
Source
Foot & Ankle International. 19(3):153-6, 1998 Mar.
Abstract
The impulse distribution based upon vertical foot-floor reaction forces
and time under the fore-, mid-, and hindfoot was determined using
Tekscan's F-Scan system. This was compared in 40 barefoot patients with
long-standing plantar fasciitis with an equal number of normal subjects.
The patient group tended to load the hind- and midfoot to a lesser extent
than the control group. Consequently, a greater proportionate load was
borne by the forefoot. This result was highly significant for both the
midfoot (P < 0.001) and forefoot (P = 0.002) comparisons. An objective
biomechanical method such as this may be useful as a diagnostic aid, to
identify individuals predisposed to this condition, and for evaluating
the efficacy of various treatment modalities.
<27>
Unique Identifier
10808974
Medline Identifier
20266971
Authors
Leppilahti J. Lahde S. Forsman K. Kangas J. Kauranen K. Orava S.
Institution
Department of Surgery, Oulu University Hospital, Finland.
Title
Relationship between calf muscle size and strength after achilles
rupture repair.
Source
Foot & Ankle International. 21(4):330-5, 2000 Apr.
Abstract
The object was to study the relationships between calf muscle size and
strength in 85 patients an average of 3.1 years after repair of achilles
tendon rupture. The isokinetic calf muscle strength results were
excellent or good for 73% of the patients, whereas calf muscle size was
normal in only 30%. The average plantar flexion peak torque per unit
muscle cross-sectional area was higher on the injured side than on the
uninjured side. The average calf muscle cross-sectional area deficit was
15+/-9% (p<0.001) of that on the unaffected side, while the average
plantar flexion peak torque deficit was speed-dependent, being 9+/-18%,
10+/-18 and 2+/-13% of that on the unaffected side at 30, 90, and 240
degrees/sec (p<0.001). The correlation between cross-sectional area and
peak torque varied in the range 0.52-0.61 at 30, 90 and 240 degrees/sec
(p<0.001).
<28>
Unique Identifier
11858336
Medline Identifier
21847130
Authors
Wearing SC. Smeathers JE. Urry SR.
Institution
Centre for Public Health Research, School of Public Health, Queensland
University of Technology, Australia. s.wearing@qut.edu.au
Title
A comparison of two analytical techniques for detecting differences in
regional vertical impulses due to plantar fasciitis.
Source
Foot & Ankle International. 23(2):148-54, 2002 Feb.
Abstract
The vertical impulse distribution beneath the foot has been shown to be
a useful objective method for evaluating gait and the efficacy of
treatment programs. However, recent studies employing similar methods,
but different analytical techniques, have reached divergent conclusions
regarding the effect of plantar fasciitis on hindfoot, midfoot and
forefoot impulses. The aim of the current study was to determine whether
the impulse distribution beneath the hindfoot, midfoot and forefoot in
subjects with, and without, plantar fasciitis was dependent on the
analytic technique employed. A pressure platform was used to collect
impulse estimates from 16 subjects with plantar fasciitis, and 16 control
subjects, while walking at their preferred speed. The findings indicate
that an impulse calculation incorporating the position of the center of
pressure is more effective in detecting alterations in gait than the
conventional method of estimating the impulse distribution beneath the
foot. This study also demonstrates that subjects with plantar fasciitis
possess modified gait patterns that are primarily manifest by a reduced
hindfoot and an increased midfoot impulse, as defined by the pathway of
the center of pressure.
<29>
Unique Identifier
10609710
Medline Identifier
20075801
Authors
Davies MS. Weiss GA. Saxby TS.
Title
Plantar fasciitis: how successful is surgical intervention?.
Source
Foot & Ankle International. 20(12):803-7, 1999 Dec.
Abstract
Forty-three patients (47 heels) underwent decompression of the nerve to
abductor digiti minimi with partial plantar fascia release for
intractable plantar fasciitis over a 4-year period. Forty-one patients
(45 heels) were available for follow-up. All of the patients had failed
to respond to nonoperative treatment. The mean duration of symptoms
before surgery was 34.8 months (range, 12-132 months), and the mean
follow-up was 31.4 months (range, 11-66 months). Seventy percent of the
patients in the study were overweight or obese. Before surgery, 39
patients (43 heels) rated their heel pain as severe. At follow-up, 34 of
45 (75.6%) of the heels were pain-free or only mildly painful. The mean
visual analogue pain score dropped from 8.5 of 10 preoperatively to 2.5
of 10 postoperatively. Only four patients failed to report an improvement
in their activity restrictions, and only one patient had a walking
distance of under 100 m after surgery; this patient had been affected by
a reflex sympathetic dystrophy. Overall, however, only 20 of 41 patients
were totally satisfied with the outcome (48.8%). We recommend that the
small group of patients who fail to respond to nonoperative treatment be
considered for surgical intervention. The results in terms of symptomatic
relief are generally good but in terms of patient satisfaction can only
be rated as moderate. The patients should be counseled about the likely
outcome of surgery.
<30>
Unique Identifier
9577272
Medline Identifier
98238133
Authors
Anonymous.
Title
I have recently taken up fast walking and have developed pain in my
left foot, which my internist says in plantar fasciitis. She told me to
hold off on walking for a while. Can you tell me about this condition? Is
there anything else I can do to speed my recovery?.
Source
Harvard Women's Health Watch. 5(8):8, 1998 Apr.
<31>
Unique Identifier
10211195
Medline Identifier
99227641
Authors
Houshian S. Tscherning T. Riegels-Nielsen P.
Institution
Department of Orthopaedic Surgery T, Esbjerg County Hospital, Denmark.
Title
The epidemiology of Achilles tendon rupture in a Danish county.
Source
Injury. 29(9):651-4, 1998 Nov.
Abstract
The epidemiology of Achilles tendon ruptures was examined during the
13-year period 1984-1996 in a Danish county. Five hospitals, serving a
population of 220,000 cooperated. There were 718 ruptures, 544 men
(75.8%) and 174 women (24.2%). The male to female ratio was 3:1. The
average age was 42.1 years (3-82) and 62% were between 30-49 years. 74.2%
of the ruptures were sport-related and 89% of these occurred in ball and
racket games. The annual incidence of achilles tendon ruptures increased
from 18.2/10(5) inhabitants in 1984 to 37.3/10(5) in 1996. The peak
incidence in sport-related ruptures occurred in the age group 30-49
years, but ruptures not related to sport occurred in older patients with
a peak incidence in those 50-59 years.
<32>
Unique Identifier
10505123
Medline Identifier
99434748
Authors
Gorschewsky O. Vogel U. Schweizer A. van Laar B.
Institution
Klink Permanence, Clinic for Sports Traumatology, Berne, Switzerland.
Title
Percutaneous tenodesis of the Achilles tendon. A new surgical method
for the treatment of acute Achilles tendon rupture through percutaneous
tenodesis.
Source
Injury. 30(5):315-21, 1999 Jun.
Abstract
Various studies have shown that the operative treatment of a freshly
ruptured Achilles tendon is generally considered to be more appropriate
than a nonoperative regimen. However, complications in open
reconstructions are reported to occur between 11-29%. We intended to
develop a method which reduces the risk of complications arising from
operation but simultaneously allows early postoperative mobilization and
functional treatment. We developed a percutaneous tenodesis of the
Achilles tendon, using two Lengemann extension wires for adaptation of
the ruptured tendon. This method of treatment has been applied in 20
patients. The postoperative observation period was one year. All patients
were male, their average age was 42 years. The Achilles tendon ruptures
occurred during sporting activities and were treated by operation within
22 h on average. The outcome was very good in 95%. One patient (5%)
suffered a rerupture due to trauma. There was no other complication.
<33>
Unique Identifier
10098046
Medline Identifier
99198119
Authors
Myerson MS. McGarvey W.
Institution
Foot and Ankle Services, Union Memorial Hospital, Baltimore, Maryland,
USA.
Title
Disorders of the Achilles tendon insertion and Achilles tendinitis.
[Review] [52 refs]
Source
Instructional Course Lectures. 48:211-8, 1999.
<34>
Unique Identifier
10098047
Medline Identifier
99198120
Authors
Myerson MS.
Institution
Foot and Ankle Services, Union Memorial Hospital, Baltimore, Maryland,
USA.
Title
Achilles tendon ruptures. [Review] [64 refs]
Source
Instructional Course Lectures. 48:219-30, 1999.
<35>
Unique Identifier
9571443
Medline Identifier
98232934
Authors
Jones DC.
Institution
University of Oregon Athletic Department, OHSU, Eugene, USA.
Title
Achilles tendon problems in runners. [Review] [35 refs]
Source
Instructional Course Lectures. 47:419-27, 1998.
<36>
Unique Identifier
9506804
Medline Identifier
98165649
Authors
Pieper HG. Radas CB. Quack G. Krahl H.
Institution
Department of Orthopaedic Surgery and Sports Medicine, Alfried Krupp
Hospital, Essen, Germany.
Title
Mediomalleolar fracture combined with Achilles tendon rupture--a rare
simultaneous injury of the ankle.
Source
International Journal of Sports Medicine. 19(1):68-70, 1998 Jan.
Abstract
Achilles tendon injuries are rarely associated with osseous lesions.
The combination of mediomalleolar fracture with Achilles tendon rupture
has been reported as a rare combination injury in alpine skiers, but
never before in basketball. This report presents an Achilles tendon
rupture in a senior basketball player in combination with a non-displaced
fracture of the medial malleolus. The osseous lesion was initially
missed, because the tendon injury with all typical clinical and
sonographical signs predominated. The routine X-ray examination was only
done in the lateral and axial plane, because the examiner did not even
think of an ankle fracture, since the description of the sports accident
and the clinical signs were so typical for a sole tendon injury. This
case report should remind us not to exclude an osseous or ligamentous
ankle injury in those cases of acute Achilles tendon rupture especially
if postoperative swelling and pain persist for a prolonged period.
<37>
Unique Identifier
10428130
Medline Identifier
99355084
Authors
Mortensen HM. Skov O. Jensen PE.
Institution
Department of Orthopaedics, Odense University Hospital, Denmark.
niels.mortensen@dadlnet.dk
Title
Early motion of the ankle after operative treatment of a rupture of the
Achilles tendon. A prospective, randomized clinical and radiographic
study.
Source
Journal of Bone & Joint Surgery. 81(7):983-90, 1999 Jul.
Abstract
BACKGROUND: Different regimens of early motion of the ankle after
operative treatment of a ruptured Achilles tendon have been suggested
since the late 1980s. However, as far as we know, no controlled studies
comparing these regimens with conventional immobilization in a cast have
been reported. METHODS: In a prospective study, seventy-one patients who
had an acute rupture of the Achilles tendon were randomized to either
conventional postoperative management with a cast for eight weeks or
early restricted motion of the ankle in a below-the-knee brace for six
weeks. The brace was modified with an elastic band on the posterior
surface, in a manner similar to the principle of Kleinert traction. Metal
markers were placed in the tendon, and the separation between them was
measured on serial radiographs during the first twelve weeks
postoperatively. The patients were assessed clinically when the cast or
brace was removed, at twelve weeks postoperatively, and at a median of
sixteen months postoperatively. RESULTS: The separation between the
markers at twelve weeks postoperatively was nearly identical in the two
groups, with a median separation of 11.5 millimeters (range, zero to
thirty-three millimeters) in the patients managed with early motion of
the ankle and nine millimeters (range, one to forty-one millimeters) in
the patients managed with a cast. The separation was primarily correlated
with the initial tautness of the repair (r[S] = 0.45). No patient had
excessive lengthening of the tendon. The patients managed with early
motion had a smaller initial loss in the range of motion, and they
returned to work and sports activities sooner than those managed with a
cast. Furthermore, there were fewer visible adhesions between the
repaired tendon and the skin in the patients managed with early motion,
and these patients were subjectively more satisfied with the overall
result. The patients in both groups recovered a median of 89 percent of
strength of plantar flexion compared with that of the noninjured limb, as
measured with an isometric strain-gauge at 15 degrees of dorsiflexion.
The heel-rise index was similar for both groups: 0.88 for the patients
managed with early motion and 0.89 for those managed with a cast.
CONCLUSIONS: Early restricted motion appears to shorten the time needed
for rehabilitation. There were no complications related to early motion
in these patients. However, early unloaded exercises did not prevent
muscle atrophy.
<38>
Unique Identifier
11886900
Medline Identifier
21883994
Authors
Rompe JD. Schoellner C. Nafe B.
Institution
Department of Orthopaedics, Johannes Gutenberg University School of
Medicine, Mainz, Germany. rompe@mail.uni-mainz.de
Title
Evaluation of low-energy extracorporeal shock-wave application for
treatment of chronic plantar fasciitis.
Source
Journal of Bone & Joint Surgery. 84-A(3):335-41, 2002 Mar.
Abstract
BACKGROUND: Although the application of low-energy extracorporeal shock
waves to treat musculoskeletal disorders is controversial, there has been
some limited, short-term evidence of its effectiveness for the treatment
of chronic plantar fasciitis. METHODS: From 1993 to 1995, a prospective,
two-tailed, randomized, controlled, observer-blinded pilot trial was
performed to assess whether three applications of 1000 impulses of lowenergy shock waves (Group I) led to a superior clinical outcome when
compared with three applications of ten impulses of low-energy shock
waves (Group II) in patients with intractable plantar heel pain. The
sample size was 112. The main outcome measure was patient satisfaction
according to a four-step score (excellent, good, acceptable, and poor) at
six months. Secondary outcome measures were patient satisfaction
according to the four-step score at five years and the severity of pain
on manual pressure, at night, and at rest as well as the ability to walk
without pain at six months and five years. RESULTS: At six months, the
rate of good and excellent outcomes according to the four-step score was
significantly (47%) better (p < 0.0001) in Group I than in Group II. As
assessed on a visual analog scale, the score for pain caused by manual
pressure at six months had decreased to 19 points, from 77 points before
treatment, in Group I, whereas in Group II the ratings before treatment
and at six months were 79 and 77 points (p < 0.0001 for the difference
between groups). In Group I, twenty-five of forty-nine patients were able
to walk completely without pain at six months compared with zero of
forty-eight patients in Group II (p < 0.0001). By five years, the
difference in the rates of good and excellent outcomes according to the
four-step score was only 11% in favor of Group I (p = 0.071) because of a
high rate of good and excellent results from subsequent surgery in Group
II; the score for pain caused by manual pressure had decreased to 9
points in Group I and to 29 points in Group II (p = 0.0006 for the
difference between groups). At five years, five (13%) of thirty-eight
patients in Group I had undergone an operation of the heel compared with
twenty-three (58%) of forty patients in Group II (p < 0.0001).
CONCLUSIONS: Three treatments with 1000 impulses of low-energy shock
waves appear to be an effective therapy for plantar fasciitis and may
help the patient to avoid surgery for recalcitrant heel pain. In
contrast, three applications of ten impulses did not improve symptoms
substantially.
<39>
Unique Identifier
11861742
Medline Identifier
21850772
Authors
Mert G.
Title
Rupture of the Achilles tendon in athletes: do synthetic grass fields
play a part?.
Source
Journal of Bone & Joint Surgery. 84-A(2):320-1, 2002 Feb.
<40>
Unique Identifier
10530854
Medline Identifier
99458437
Authors
Webb JM. Bannister GC.
Institution
Southmead Hospital, Bristol, England.
Title
Percutaneous repair of the ruptured tendo Achillis. [see comments.].
Comments
Comment in: J Bone Joint Surg Br. 2000 Apr;82(3):461 ; 10813190,
Comment in: J Bone Joint Surg Br. 2000 May;82(4):619 ; 10855894
Source
Journal of Bone & Joint Surgery - British Volume. 81(5):877-80, 1999
Sep.
Abstract
Percutaneous repair of the ruptured tendo Achillis has a low rate of
failure and negligible complications with the wound, but the sural nerve
may be damaged. We describe a new technique which minimises the risk of
injury to this nerve. The repair is carried out using three midline stab
incisions over the posterior aspect of the tendon. A No. 1 nylon suture
on a 90 mm cutting needle approximates the tendon with two box stitches.
The procedure can be carried out under local anaesthesia. We reviewed 27
patients who had a percutaneous repair at a median interval of 35 months
after the injury. They returned to work at four weeks and to sport at 16.
One developed a minor wound infection and another complex regional pain
syndrome type II. There were no injuries to the sural nerve or late
reruptures. This technique is simple to undertake and has a low rate of
complications.
<41>
Unique Identifier
10705593
Medline Identifier
20169771
Authors
Wilk BR. Fisher KL. Gutierrez W.
Institution
Orthopedic Rehabilitation Specialists, Miami, Fla. 33176, USA.
info@defectiveshoe.com
Title
Defective running shoes as a contributing factor in plantar fasciitis
in a triathlete.
Source
Journal of Orthopaedic & Sports Physical Therapy. 30(1):21-8;
discussion 29-31, 2000 Jan.
Abstract
STUDY DESIGN: Case study of a patient who developed plantar fasciitis
after completing a triathlon. OBJECTIVES: To describe the factors
contributing to the injury, describe the rehabilitation process,
including the analysis of defective athletic shoe construction, and
report the clinical outcome. BACKGROUND: Plantar fasciitis has been found
to be a common overuse injury in runners. Studies that describe causative
factors of this syndrome have not documented the possible influence of
faulty athletic shoe construction on the symptoms of plantar fasciitis.
METHODS AND MEASURES: The patient was a 40-year-old male triathlete who
was followed up for an initial evaluation and at weekly intervals up to
discharge 4 weeks after injury and at 1 month following discharge.
Perceived heel pain, ankle strength, and range of motion were the primary
outcome measures. Shoe construction was evaluated to assess the integrity
of shoe manufacture and wear of materials by visual inspection of how
shoe parts were glued together, if shoe parts were assembled with proper
relationship to each other, if the shoe sole was level when resting on a
level surface, and if the sole allowed unstable motion. RESULTS: The
patient appeared to have a classic case of plantar fasciitis with a
primary symptom of heel pain at the calcaneal origin of the plantar
fascia. On initial evaluation, right heel pain was a 9 of 10, plantar
flexion strength was a 3+/5, and ankle dorsiflexion motion was 10
degrees. One month after discharge, perceived heel pain was 0, plantar
flexion strength was 5/5, and dorsiflexion motion was 15 degrees and
equal to the uninvolved extremity. The right running shoe construction
deficit was a heel counter that was glued into the shoe at an inward
leaning angle, resulting in a greater medial tilt of the heel counter
compared with the left shoe. The patient was taught how to examine the
integrity of shoe manufacture and purchased a new pair of sound running
shoes. CONCLUSIONS: A running shoe manufacturing defect was found that
possibly contributed to the development of plantar fasciitis. Assessing
athletic shoe construction may prevent lower extremity overuse injuries.
<42>
Unique Identifier
10612073
Medline Identifier
20078197
Authors
Cornwall MW. McPoil TG.
Institution
Department of Physical Therapy, Northern Arizona University, Flagstaff
86011, USA. mark.cornwall@nau.edu
Title
Plantar fasciitis: etiology and treatment. [see comments.]. [Review]
[48 refs]
Comments
Comment in: J Orthop Sports Phys Ther. 2000 Apr;30(40:217
Source
Journal of Orthopaedic & Sports Physical Therapy. 29(12):756-60, 1999
Dec.
Abstract
Plantar fasciitis is a common pathological condition of the foot and
can often be a challenge for clinicians to successfully treat. The
purpose of this article is to present and discuss selected literature on
the etiology and clinical outcome of treating plantar fasciitis. Surgical
and nonsurgical techniques have been used in the treatment of plantar
fasciitis. Nonsurgical management for the treatment of the symptoms and
discomfort associated with plantar fasciitis can be classified into 3
broad categories: reducing pain and inflammation, reducing tissue stress
to a tolerable level, and restoring muscle strength and flexibility of
involved tissues. Each of these treatments has demonstrated some level of
effectiveness in alleviating the symptoms of plantar fasciitis. Previous
studies have grouped all forms of nonsurgical therapy together. It is,
therefore, difficult to determine if one type of treatment is more
effective compared with another. Until such research is available, the
clinician would be wise to include treatments from all 3 categories.
[References: 48]
<43>
Unique Identifier
10993087
Medline Identifier
20445183
Authors
Taniguchi Y. Tamaki T.
Institution
Department of Orthopaedic Surgery, Wakayama Medical College, Japan.
Title
Reconstruction of the achilles tendon and overlying skin defect with a
medical plantar flap and tensor fasciae latae graft.
Source
Journal of Reconstructive Microsurgery. 16(6):423-5, 2000 Aug.
Abstract
The authors report a case of Achilles tendon and skin defect treated
with an island medial plantar flap and fascia lata graft with very
satisfactory results.
<44>
Unique Identifier
9753759
Medline Identifier
98428729
Authors
Saltzman CL. Tearse DS.
Institution
Department of Orthopaedic Surgery and Department of Biomedical
Engineering, University of Iowa, Iowa City, IA 52242, USA.
Title
Achilles tendon injuries. [Review] [18 refs]
Source
Journal of the American Academy of Orthopaedic Surgeons. 6(5):316-25,
1998 Sep-Oct.
Abstract
As the number of persons who participate in athletic activity into
their later years has increased, so has the incidence of overuse injuries
to the Achilles tendon. The etiology of these problems is multifactorial
and includes biomechanical factors and training errors. Use of a
histopathologic scheme for classification of these injuries facilitates a
logical approach to treatment. Conservative care is a mainstay of
treatment for inflammatory conditions. Satisfactory outcomes may be
obtained with either nonoperative or operative treatment of acute
ruptures, although surgically treated patients appear to recover better
functional capacity. Treatment of neglected injuries to the Achilles
tendon continues to be a challenging problem. [References: 18]
<45>
Unique Identifier
9785751
Medline Identifier
99001930
Authors
Neitzschman HR.
Institution
Louisiana State University Medical Center, New Orleans, USA.
Title
Radiology case of the month. Painful heel following exercise. Lipoma of
the os-calcis.
Source
Journal of the Louisiana State Medical Society. 150(9):407-8, 1998
Sep.
<46>
Unique Identifier
11819023
Medline Identifier
21676768
Authors
Fahlstrom M. Lorentzon R. Alfredson H.
Institution
Department of Surgical and Perioperative Science, University of Umea,
90187 Umea, Sweden.
Title
Painful conditions in the Achilles tendon region: a common problem in
middle-aged competitive badminton players.
Source
Knee Surgery, Sports Traumatology, Arthroscopy. 10(1):57-60, 2002 Jan.
Abstract
Overuse injuries are the most frequent type in badminton, generally
localized in the legs. An earlier study found 32% of young Swedish elite
badminton players to have experienced disabling pain in the Achilles
tendon region during the previous 5 years. The present investigation
examined the prevalence and characteristics of painful conditions in the
Achilles tendon region in 32 middle-aged competitive badminton players by
means of questionnaire and physiotherapist's examination. Pain in the
Achilles tendon region was reported by 44%, either presently or during
the past 5 years, generally localized in the middle portion of the
tendon. Symptoms had lasted 2 weeks-1 year (96 days). On the competition
days 22% of the reported pain currently in the region. Age was found to
be correlated to Achilles tendon pain, but there was no relationship
between symptoms of pain and body mass index, gender, training quantity,
or years of playing badminton. In conclusion, Achilles tendon pain seems
to be relatively common among Swedish middle-aged competitive badminton
players, particularly in the older ones.
<47>
Unique Identifier
11932562
Medline Identifier
21930234
Authors
Testa V. Capasso G. Benazzo F. Maffulli N.
Institution
Dynamic Center, Angri, Italy.
Title
Management of Achilles tendinopathy by ultrasound-guided percutaneous
tenotomy.
Source
Medicine & Science in Sports & Exercise. 34(4):573-80, 2002 Apr.
Abstract
PURPOSE: To report the middle to long-term results of ultrasound-guided
percutaneous longitudinal tenotomy of the Achilles tendon METHOD:
Seventy-five athletes with unilateral Achilles tendinopathy underwent
ultrasound-guided percutaneous longitudinal tenotomy under local
anesthetic infiltration after failure of conservative management. Sixtythree patients were reviewed at least 36 months after the operation (51
+/- 18.2 months). RESULTS: Thirty-five patients were rated excellent, 12
good, 9 fair, and 7 poor. Nine of the 16 patients with a fair or poor
result underwent a formal exploration of the Achilles tendon 7-12 months
after the index procedure. The operated tendons remained thickened and
the ultrasonographic appearance of operated tendons remained abnormal
even 8 yr after the operation, without interfering with physical
training. Isometric maximal muscle strength and isometric endurance
gradually returned to values similar to their contralateral unoperated
tendon. CONCLUSIONS: Percutaneous longitudinal ultrasound-guided internal
tenotomy is simple, can be performed on an outpatient basis, requires
minimal follow-up care, does not hinder further surgery should it be
unsuccessful, and, in our experience, has produced no significant
complications. It should be considered in the management of chronic
Achilles tendinopathy after failure of conservative management. However,
patients should be advised that, if they suffer from diffuse or
multinodular tendinopathy or from pantendinopathy, a formal surgical
exploration with stripping of the paratenon and multiple longitudinal
tenotomies may be preferable.
<48>
Unique Identifier
10628159
Medline Identifier
20093646
Authors
Davis JJ. Mason KT. Clark DA.
Institution
U.S. Aeromedical Center, Department of Aviation Medicine, Fort Rucker,
AL 36362, USA.
Title
Achilles tendon ruptures stratified by age, race, and cause of injury
among active duty U.S. Military members.
Source
Military Medicine. 164(12):872-3, 1999 Dec.
Abstract
A total of 865 members of the U.S. military underwent repair of
Achilles tendon ruptures at U.S. military hospitals during calendar years
1994, 1995, and 1996. The discharge summaries of these patients were
analyzed for patient demographic information, including age, race, and
causative activity. Patients were then stratified by age, race, and cause
of injury. Blacks were at increased risk for undergoing repair of the
Achilles tendon compared with nonblacks (overall relative risk = 4.15,
95% confidence interval [CI] = 3.63, 4.74; summary odds ratio controlling
for age = 3.69, CI = 3.25, 4.19). Participation in the game of basketball
accounted for 64.9% of all injuries in black patients and 34.0% of all
injuries in nonblack patients. Among those injured, blacks had a
significantly increased risk for injury related to playing basketball
than nonblacks (relative risk = 1.82, CI = 1.58, 2.10). This finding
suggests that there may be other predisposing factor(s) that result in a
higher risk of Achilles tendon ruptures in black individuals.
<49>
Unique Identifier
10386806
Medline Identifier
99313377
Authors
Traina SM. Yonezuka NY. Zinis YC.
Institution
Denver Orthopedic Specialists, Colorado 80218, USA.
Title
Achilles tendon injury in a professional basketball player. [see
comments.].
Comments
Comment in: Orthopedics. 1999 Oct;22(10):909 ; 10535550
Source
Orthopedics.
22(6):625-6, 1999 Jun.
<50>
Unique Identifier
11129177
Medline Identifier
21011591
Authors
Mine R. Fukui M. Nishimura G.
Institution
Department of Plastic and Reconstructive Surgery, Fukuoka Tokushukai
Medical Center, Japan. plastic@surgery.club.ne.jp
Title
Bicycle spoke injuries in the lower extremity.
Source
Plastic & Reconstructive Surgery. 106(7):1501-6, 2000 Dec.
Abstract
This study reports the authors' 5-year experience with treating lower
extremity injuries in bicycle passengers caused by the spokes. This
patient group was selected from 716 lower extremity injuries that
received treatment at our outpatient plastic surgery clinic. A total of
26 patients were treated during the study. Patients ranged from 2 to 19
years old, with a mean age of 5.6 years. The authors treated more female
passengers (62 percent) than male passengers. The right foot (52 percent)
was involved more often than was the left. Most patients were injured in
the afternoon, from 2 to 7 PM (62 percent), and between May and October
(77 percent). The rear wheel (89 percent) injured the majority of
patients. The Achilles tendon was the most common site of injury (63
percent). The typical types of wounds observed included the following:
type I, laceration with partial avulsion of skin and subcutaneous tissue
(41 percent) and laceration forming a distally based flap (33 percent);
type II, abrasions with ecchymoses and friction burn from the shearing
effect of the spokes creating a partial- to full-thickness skin defect
(26 percent). Of the type I injuries, full-thickness skin lacerations (33
percent) were closed primarily. Partial-thickness skin lacerations,
abrasions, ecchymoses, and skin defects (67 percent) were treated
conservatively with wound irrigation and dressing. The wound healing time
for type I injuries was 29 days; for type II injuries, it was 27 days.
These healing times were prolonged compared with healing by first
intention. No significant difference was found in healing time when
comparing both types of injury. Four patients required hospitalization.
No patient required skin grafting. No fractures were noted because these
patients were selected from the outpatient plastic surgery clinic and did
not include patients from the emergency room. Since the first report of
bicycle spoke injuries a half-century ago, prevention has not improved.
<51>
Unique Identifier
11476424
Medline Identifier
21368662
Authors
Silbernagel KG. Thomee R. Thomee P. Karlsson J.
Institution
Sportrehab--Physical Therapy & Sports Medicine Clinic, Goteborg,
Sweden.
Title
Eccentric overload training for patients with chronic Achilles tendon
pain--a randomised testing of the evaluation methods.
Source
Scandinavian Journal of Medicine & Science in Sports. 11(4):197-206,
2001 Aug.
Abstract
The purpose was to examine the reliability of measurement techniques
and evaluate the effect of a treatment protocol including eccentric
overload for patients with chronic pain from the Achilles tendon. Thirtytwo patients with proximal achillodynia (44 involved Achilles tendons)
participated in tests for reliability measures. No significant
differences and strong (r=0.56-0.72) or very strong (r=0.90-0.93)
correlations were found between pre-tests, except for the documentation
of pain at rest (P<0.008, r=0.45). To evaluate the effect of a 12-week
treatment protocol for patients with chronic proximal achillodynia (pain
longer than three months) 40 patients (57 involved Achilles tendons) with
a mean age of 45 years (range 19-77) were randomised into an experiment
group (n=22) and a control group (n=18). Evaluations were performed after
six weeks of treatment and after three and six months. The evaluations
(including the pre-tests), performed by a physical therapist unaware of
the group the patients belonged to, consisted of a questionnaire, a range
of motion test, a jumping test, a toe-raise test, a pain on palpation
test and pain evaluation during jumping, toe-raises and at rest. A
follow-up was also performed after one year. There were no significant
differences between groups at any of the evaluations, except that the
experiment group jumped significantly lower than the control group at the
six-week evaluation. There was, however, an overall better result for the
experiment group with significant improvements in plantar flexion, and
reduction in pain on palpation, number of patients having pain during
walking, having periods when asymptomatic and having swollen Achilles
tendon. The controls did not show such changes. Furthermore, at the oneyear follow-up there were significantly more patients in the experiment
group, compared with the control group, that were satisfied with their
present physical activity level, considered themselves fully recovered,
and had no pain during or after physical activity. The measurement
techniques and the treatment protocol with eccentric overload used in the
present study can be recommended for patients with chronic pain from the
Achilles tendon.
<52>
Unique Identifier
11476425
Medline Identifier
21368663
Authors
Ohberg L. Lorentzon R.
Institution
Alfredson H.
Department of Surgical and Perioperative Science, National Institute
for Working Life, University of Umea, Sweden.
Title
Good clinical results but persisting side-to-side differences in calf
muscle strength after surgical treatment of chronic Achilles tendinosis:
a 5-year follow-up.
Source
Scandinavian Journal of Medicine & Science in Sports. 11(4):207-12,
2001 Aug.
Abstract
We have prospectively studied calf muscle strength (isokinetic
concentric and eccentric muscle strength at 90 degrees/s and 225
degrees/s of angular velocity in 24 patients (17 males and 7 females,
mean age 43.0 years) surgically treated for chronic Achilles tendinosis
(at the 2-6 cm level in the tendon). The mean follow-up time was 5 years
(range 31-82 months). Surgery was followed by immobilization in a weightbearing below the knee plaster cast for 2-6 weeks, followed by a stepwise
increasing strength training programme. Strength measurements (peak
torque) were done preoperatively, and 1 and 5 (mean) years
postoperatively. Preoperatively, concentric plantar flexion peak torque
at 90 degrees/s and 225 degrees/s and eccentric plantar flexion torque at
90 degrees/s were significantly lower (12.3%, 19.7% and 8.5%
respectively) on the injured side compared to the non-injured side.
Postoperatively, at the 5-year follow-up, 22 out of 24 patients (92%)
were satisfied with the operation and active at their desired level
(running, tennis, badminton, walking). There was no significant increase
in concentric and eccentric calf muscle strength postoperatively.
Concentric plantar flexion peak torque at 90 degrees/s and 225 degrees/s
and eccentric plantar flexion peak torque at 90 degrees/s were still
significantly lower (7.2%, 8.6% and 8.8% respectively) on the injured
side compared to the non-injured side. In conclusion it seems that the
calf muscle strength deficit seen on the injured side preoperatively in
this group of patients remains despite 92% of the patients being painfree and active in sports or at recreational level after the operation.
However, the percentage side-to-side difference is relatively low, and
might not have any clinical relevance.
<53>
Unique Identifier
11476423
Medline Identifier
21368661
Authors
Kjaer M.
Title
The treatment of overuse injuries in sports.
Source
Scandinavian Journal of Medicine & Science in Sports.
2001 Aug.
<54>
Unique Identifier
11(4):195-6,
11476424
Medline Identifier
21368662
Authors
Silbernagel KG. Thomee R. Thomee P. Karlsson J.
Institution
Sportrehab--Physical Therapy & Sports Medicine Clinic, Goteborg,
Sweden.
Title
Eccentric overload training for patients with chronic Achilles tendon
pain--a randomised controlled study with reliability testing of the
evaluation methods.
Source
Scandinavian Journal of Medicine & Science in Sports. 11(4):197-206,
2001 Aug.
Abstract
The purpose was to examine the reliability of measurement techniques
and evaluate the effect of a treatment protocol including eccentric
overload for patients with chronic pain from the Achilles tendon. Thirtytwo patients with proximal achillodynia (44 involved Achilles tendons)
participated in tests for reliability measures. No significant
differences and strong (r=0.56-0.72) or very strong (r=0.90-0.93)
correlations were found between pre-tests, except for the documentation
of pain at rest (P<0.008, r=0.45). To evaluate the effect of a 12-week
treatment protocol for patients with chronic proximal achillodynia (pain
longer than three months) 40 patients (57 involved Achilles tendons) with
a mean age of 45 years (range 19-77) were randomised into an experiment
group (n=22) and a control group (n=18). Evaluations were performed after
six weeks of treatment and after three and six months. The evaluations
(including the pre-tests), performed by a physical therapist unaware of
the group the patients belonged to, consisted of a questionnaire, a range
of motion test, a jumping test, a toe-raise test, a pain on palpation
test and pain evaluation during jumping, toe-raises and at rest. A
follow-up was also performed after one year. There were no significant
differences between groups at any of the evaluations, except that the
experiment group jumped significantly lower than the control group at the
six-week evaluation. There was, however, an overall better result for the
experiment group with significant improvements in plantar flexion, and
reduction in pain on palpation, number of patients having pain during
walking, having periods when asymptomatic and having swollen Achilles
tendon. The controls did not show such changes. Furthermore, at the oneyear follow-up there were significantly more patients in the experiment
group, compared with the control group, that were satisfied with their
present physical activity level, considered themselves fully recovered,
and had no pain during or after physical activity. The measurement
techniques and the treatment protocol with eccentric overload used in the
present study can be recommended for patients with chronic pain from the
Achilles tendon.
<55>
Unique Identifier
11085559
Medline Identifier
20536009
Authors
Kjaer M. Langberg H. Skovgaard D. Olesen J. Bulow J. Krogsgaard M.
Boushel R.
Institution
Sports Medicine Research Unit, Bispebjerg University Hospital,
Copenhagen, Denmark.
Title
In vivo studies of peritendinous tissue in exercise. [Review] [34 refs]
Source
Scandinavian Journal of Medicine & Science in Sports. 10(6):326-31,
2000 Dec.
Abstract
Soft tissue injury of tendons represents a major problem within sports
medicine. Although several animal and cell culture studies have addressed
this, human experiments have been limited in their ability to follow
changes in specific tissue directly in response to interventions.
Recently, methods have allowed for in vivo determination of tissue
concentrations and release rates of substances involved in metabolism,
inflammation and collagen synthesis, together with the measurement of
tissue blood flow and oxygenation in the peritendinous region around the
Achilles tendon in humans during exercise. It can be demonstrated that
this region experiences an increase in blood flow during both static and
dynamic exercise, and that exercise causes increased metabolic activity,
accumulation of inflammatory mediators (prostaglandins) and increased
formation of collagen type I in response to acute exercise. This
coincides with a surprisingly marked drop in tissue pressure during
contraction. With regards to both circulation, metabolism and collagen
formation, peritendinous tissue represents a dynamic, responsive region
that adapts markedly to acute muscular activity. [References: 34]
<56>
Unique Identifier
9659674
Medline Identifier
98323859
Authors
Fahlstrom M. Bjornstig U. Lorentzon R.
Institution
Rehabilitation Medicine Clinic, University Hospital of Umea, Sweden.
Title
Acute badminton injuries.
Source
Scandinavian Journal of Medicine & Science in Sports. 8(3):145-8, 1998
Jun.
Abstract
During 1990-1994, 1.2% of all sports injuries that required emergency
care at the University Hospital of Umea were caused by badminton. In
90.7% of the cases the patients described themselves as recreational
players or beginners. There were 51.3% minor injuries (AIS 1) and 48.7%
moderate injuries (AIS 2). The lower extremities were affected in 92.3%
of the cases. Achilles tendon ruptures (34.6%) and ankle sprains and
fractures (29.5%) were the most frequent. By the time of the follow-up
(10-69 months), 52.6% of the players still had symptoms from the injuries
and 39.5% had not been able to return to playing badminton. Our data
indicate the importance of adequate treatment and rehabilitation after
acute badminton injuries.
<57>
Unique Identifier
9519398
Medline Identifier
98179924
Authors
Leppilahti J. Orava S.
Institution
Department of Surgery, Oulu University Hospital, Finland.
Title
Total Achilles tendon rupture. A review. [Review] [233 refs]
Source
Sports Medicine. 25(2):79-100, 1998 Feb.
Abstract
There are only a few epidemiological studies on the incidence of
Achilles tendon (AT) ruptures. These show an increase in incidence in the
West during the past few decades. The main reason is probably the
increased popularity of recreational sports among middle-aged people.
Ball games constitute the cause of over 60% of AT ruptures in many
series. The 2 most frequently discussed pathophysiological theories
involve chronic degeneration of the tendon and failure of the inhibitory
mechanism of the musculotendinous unit. There are reports of AT ruptures
related to the use of corticosteroids, either systemically or locally,
but the role of corticosteroids in large patient series is marginal. In
addition, recent studies do not confirm earlier findings of blood group O
dominance in patients with AT rupture. Comparable series have been
published with surgical versus nor surgical treatment and postoperative
cast immobilisation versus early functional treatment. Although
conservative treatment has its own supporters, surgical treatment seems
to have been the method of choice in the late 1980s and the 1990s in
athletes and young people and in cases of delayed ruptures. Early
ruptures in non-athletes can also be treated conservatively. In small
series of compliant, well motivated patients, functional postoperative
treatment has been reported to be well tolerated, safe and effective. The
lack of a universal, consistent protocol for subjective and objective
evaluation of AT ruptures has prevented any direct comparison of the
results. The results have been often assessed according to the criteria
of Lindholm or Percy and Conochie, but no scoring is available for the
analysis. We assessed a new scoring method and analysed the prognostic
factors related to the results. There is also no single, uniformly
accepted surgical technique. Although early ruptures have been treated
successfully with simple end-to-end suture, many authors have combined
simple tendon suture with plastic procedures of various types. No
randomised study comparing simple suture technique and repair with
augmentation could be found in the literature. The major complaint
against surgical treatment has been the high rate of complications. Most
are minor wound complications, which delay improvement but do not
influence the final outcome. Major complications are rare, but often
difficult to treat with minor procedures. For instance, large
postoperative skin and soft tissue defects in the Achilles region can be
treated successfully with a microvascular free flap reconstruction. The
complications of conservative treatment include mostly reruptures and
residual lengthening of the tendon, which may result in significant calf
muscle weakness. It has been postulated that a physically inactive
lifestyle leads to a decrease in tendon vascularisation, while
maintenance of a continuous level of activity counteracts the structural
changes within the musculotendinous unit induced by inactivity and aging.
Proper warm-up and stretching are essential for preventing
musculotendinous injuries, but improper or excessive stretching or
warming-up can predispose to these injuries. [References: 233]