Pain in Achilles region...

[huesg001]

Hi all,

I'm working as a physio for a footy club and have had a player approach me with pain around his achilles tendon.

Problem = pain is ONLY felt when the tendon is relaxed. Palpation in DF elicits nothing. Palpation when ankle is in passive PF elicits sharp localised pain.
It is superior to the retrocalcaneal bursa and I feel no abnormal bony protruberance.

I know this isnt a very detailed Hx but its a very amatuer club and he was heading home for the night.

I've read something about it being possible for people to have an accessory soleus muscle and was wondering of the common presentation of this? I did read that it may be exacerbated by running and jumping but I havent been able to find anything else.

Any help appreciated

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[alophysio]

hi,

It is possible that he has a mid substance tendinosis in the Achilles tendon. I have noticed that with some patients the degree of stretch/relaxation of the tendon can cause different palpation results.

The Alfredson protocol is what you want to be looking for. It sucks because it is painful and long and boring and hard to do etc but it works for the right patients - pubmed should have it. Otherwise, if you have trouble finding it, email me.

Basically it is eccentric loading of the tendon to blast away blood vessels and nerves that have invaded the injury - the so called neo-vascularisation of the tendon.

See how you go - there could be other things but i would suspect the mid substance achilles tendinosis. Now the real question is "why"?