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Achilles Tendon Contracture

Achilles tendon contracture, a shortening of the Achilles tendon also known as the tendon calcaneus or heel cord, causes foot pain and strain, with limited ankle dorsiflexion.

Causes

Tendinitis can occur as a result of injury, overuse, or with aging as the tendon loses elasticity. It can also be seen in systemic diseases such as rheumatoid arthritis or diabetes. It may also be seen with certain inflammatory conditions, autoimmune disorders and some infections. Tendinitis can occur in any tendon, but some commonly affected sites are the shoulder, the wrist, the heel (Achilles tendonitis), and the elbow. Tendons are usually surrounded by a sheath of tissue similar to the lining of the joints (synovium). They're subject to the wear and tear of aging, direct injury and inflammatory diseases. The most common cause of tendinitis is injury or overuse during work or play. Occasionally, an infection within the tendon sheath is responsible for the inflammation.

Signs and Symptoms

Tendinitis causes pain over the affected tendon close to where it is inserted into the muscle. In general, tendonitis produces pain in the tissues surrounding a joint, especially after excessive use of the joint during play or work. In some cases, there also may be weakness at the involved joint, and the affected area may be red, swollen and warm to the touch. The tendon sheaths may be visibly swollen from the accumulation of fluid and inflammation. In chronic tenosynovitis, as may occur in scleroderma, the tendon sheaths may remain dry and rub against other tissues, causing a grating sensation that may be felt or a sound that may be heard with a stethoscope when the joint is moved; this is called a "tendon friction rub."

Diagnostic tests

A physical examination and patient history suggest Achilles tendon contracture.

Treatment

Conservative measures may help correct Achilles tendon contracture. Among them are raising the inside heel of the shoe in the reflex type of contracture; gradually lowering the heels of shoes (sudden lowering can aggravate the problem) and stretching exercises if the cause is high-heeled shoes; or using support braces or casting to prevent footdrop in a paralyzed patient. Alternatives include using wedged plaster casts or stretching the tendon by manipulation. Analgesics may relieve pain.

With fixed footdrop, treatment may include surgery (tenotomy) to cut the tendon and allow further stretching. After surgery, a short leg cast maintains the foot in 90-degree dorsiflexion for 6 weeks. Some patients begin partial weight bearing after 2 weeks.



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