Achilles Tendinopathy: Difference between revisions
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== | ==Clinical Features== | ||
In general, history and physical exam features are better at ruling in, rather than ruling out achilles tendinopathy. Self reported morning stiffness is the only feature with a moderate negative likelihood ratio. | In general, history and physical exam features are better at ruling in, rather than ruling out achilles tendinopathy. Self reported morning stiffness is the only feature with a moderate negative likelihood ratio. | ||
Revision as of 08:36, 20 June 2020
Clinical Features
In general, history and physical exam features are better at ruling in, rather than ruling out achilles tendinopathy. Self reported morning stiffness is the only feature with a moderate negative likelihood ratio.
| Test | Sensitivity | Specificity | LR+ | LR- | Kappa |
|---|---|---|---|---|---|
| Palpation (tenderness) | 64% | 81% | 3.15 | 0.48 | |
| Arc Sign | 42% | 88% | 3.24 | 0.68 | |
| Royal London Hospital Test | 54% | 86% | 3.84 | 0.54 | |
| Morning stiffness | 89% | 58% | 2.12 | 0.19 | |
| Palpation thickening | 59% | 90% | 5.9 | 0.46 | |
| Crepitus | 3% | 100% | inf | 0.97 | |
| Stretch on passive dorsiflexion with knee joint in flexion |
13% | 87% | 1.00 | 1.00 | |
| Single legged heel raise | 22% | 93% | 3.14 | 0.95 | |
| Hop test | 43% | 87% | 3.31 | 0.66 |
Diffuse
- Ankle (Tibiotalar) Osteoarthritis
- Subtalar Osteoarthritis
- Inflammatory arthropathies - Rheumatoid Arthritis, septic arthritis, osteomyelitis, gout, Osteonecrosis.
- Sarcoid periarthritis
- Benign or malignant neoplasms, myelodysplastic and leukaemic disorders
- Plant-thorn synovitis
- CRPS
Ankle pain persistent following injury
- Fractures - anterior process calcaneus, lateral process talus, posterior process talus (or, rare, os trigonum fracture), osteochondral lesion, tibial plafond chondral lesion, base of fifth metatarsal
- Bony impingements - anterior, posterior, anterolateral
- Atypical sprains - chronic ligamentous instability, medial ligament sprain, syndesmosis sprain (AITFL sprain), subtalar joint sprain
- Tendon injuries - chronic peroneal tendon weakness, peroneal tendon subluxation/rupture, tibialis posterior tendon subluxation/rupture
- Other - inadequate rehabilitation, chronic synovitis, sinus tarsi syndrome
Lateral Ankle Pain
- Peroneal Tendinopathy or recurrent dislocation of peroneal tendons
- Sinus Tarsi Syndrome
- Impingement syndrome (anterolateral, posterior)
- Stress fractures (talus, distal fibula)
- Referred Pain (lumbar, peroneal nerve, superior tibiofibular joint)
- Cuboid Syndrome
- Os Peroneum
- Osteochondritis dissecans (anterior lateral talus)
Medial Ankle Pain
- Tibialis Posterior Tendinopathy
- Flexor Hallucis Longus Tendinopathy
- Medial Calcaneal Nerve Entrapment
- Stress fracture (calcaneal, talar, medial malleolar, navicular)
- Tarsal Tunnel Syndrome
- Posterior Ankle Impingement
- Referred Pain from the lumbar spine
- Complications of acute ankle injuries
- Os tibiale externum (accessory navicular)
- Osteochondritis dissecans (posterior medial talus)
Posterior Ankle Pain
- Midportion Achilles Tendinopathy
- Insertional Achilles Tendinopathy
- Retrocalcaneal bursitis
- Paratenon inflammation
- Posterior impingement syndrome
- Plantaris Tendinopathy
- Sever Disease (Calcaneal Apophysitis)
- Accessory or low soleus muscle
- Referred Pain (neural structures, lumbar spine), and sural neuropathy
- Achilles tendon rupture
- Achilles enthesopathy due to inflammatory arthropathies
- Osteochondritis dissecans (posterior medial talus)
