[Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be going through achilles tendinopathy you can find written notes on this topic at zero to finals dot com slash achilles tendinopathy or in the orthopedic section of the zero to finals surgery book so let's jump straight in the achilles tendon connects the calf muscles specifically the gastronemus and soleus muscles to the heel of the foot specifically the calcaneus bone flexion of the calf muscles pulls on the achilles and causes plantar flexion of the ankle causing the foot to move in a downward direction achilles tendinopathy involves damage swelling inflammation and reduced function in the achilles tendon there are two types of achilles tendinopathy insertional tendinopathy occurs within two centimeters of the insertion point of the achilles on the calcaneus bone mid-portion tendinopathy occurs two to six centimeters above the insertion point let's talk about the risk factors a big risk factor is sports that stress the achilles tendon for example basketball tennis or track athletics other risk factors are inflammatory conditions for example rheumatoid arthritis and ankylosing spondylitis diabetes raised cholesterol and fluoroquinolone antibiotics for example ciprofloxacin and levofloxacin the tom tip for you is worth remembering the association between fluoroquinolone antibiotics and achilles tendinopathy this is a common exam question it's important to warn patients starting fluoroquinolone antibiotics to look out for signs of achilles tendinitis and stop treatment if they occur let's talk about the presentation the typical presentation is with a gradual onset of pain or aching in the achilles tendon or the heel of the foot particularly with activity there may also be stiffness tenderness swelling and nodularity of the tendon on palpation let's talk about making the diagnosis achilles tendinopathy is a clinical diagnosis and it doesn't usually require any investigations to diagnose it's essential to exclude achilles tendon rupture for example using the simmons calf squeeze test the simmons calf squeeze test is a special test to look for achilles tendon rupture or a break in the achilles tendon the patient is positioned prone or kneeling with the feet hanging freely off the end of the bench or the couch when squeezing the calf muscle in the leg with an intact achilles there will be plantar flexion of the ankle with the foot moving in a downward direction squeezing the calf muscle pulls on the achilles tendon when the achilles is ruptured the connection between the calf and the ankle is lost therefore squeezing the calf will not cause plantar flexion of the ankle a lack of plantar flexion is considered a positive result suggesting achilles tendon rupture an ultrasound scan can be used to diagnose achilles tendon rupture if suspected let's talk about the management options of achilles tendinopathy after achilles rupture has been excluded the management options are rest and altered activity to allow the tendon to heal ice to help reduce the inflammation analgesia to help with the pain physiotherapy orthotics may be useful for example insoles in the shoes to take pressure off the achilles extracorporeal shockwave therapy or eswt may be helpful and surgery may be helpful where other treatments fail and this is used to remove nodules and adhesions or alter the tendon steroid injections into the achilles tendon are avoided due to the risk of tendon rupture thank you for watching this video if you liked the video left a comment or subscribe to the channel thank you so much it really helps zero to finals is not just a youtube channel there's also a website with detailed notes illustrations and questions an instagram account where new questions are posted every day to help you test your knowledge books flash cards and much more i also have a personal channel where i share my thoughts and tips on learning medicine and you can find links to everything in the description of this video see you next time