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What are the chief complaints, causes, and pt histories of tendonopathies in the foot/ankle (achilles, posterior tibialis, peroneus longus?
Chief complaint of local pain that presents as mechanical pain (decrease with rest, and increase with activity). It is caused by inflammation in the hypo-vascular areas of the tendon with overuse (achilles with ankle PF, posterior tibialis with ankle INV & PF to counter pronation, and peroneus longus with ankle PF & eversion to assist windlass mechanism. Footwear can be a cause or contributing factor. Pt history of tendonopathies are insidious.
What are the asymmetries of feet/ankles with tendonopathies?
The tendons of the affected muscles become thickened in the avascular areas that have/had inflammatory processes. Tendonopathy of tibialis posterior & peroneus longus can create biomechanical abnormalities include pronated feet, leading to leg length discrepancies, that lead to compensations such as genu recurvatum. Tendonopathies of the achilles tendon can lead to equine deformities.
What are the ROM findings for ankles/feet with tendonopathies?
- Achilles tendonopathies may present with pain with resisted ankle PF (AROM ankle PF if highly reactive), A/PROM ankle DF at end-range.
- Posterior tibialis tendonopathies may present with decreased supination/increased pronation, pain with resisted ankle INV (AROM ankle INV if hightly reactive), A/PROM ankle EV at end-range.
- Peroneus longus tendonopathies may present with pain with resisted ankle EV (AROM ankle EV if highly reactive), A/PROM ankle INV at end range. Limited 1st MTP extension.
What are the tissue characteristics of ankles/feet with tendonopathies?
Gastroc/Soleus are decreased in length and play. The talocrucral joint capsule maybe limited in DF.
What are some special test used for tendonopathies of the ankle/foot?
- Functional testing, such as gait, jumping, etc to reproduce the comparable sign for all
- Use ANTT of sural nerve (ankle DF and INV) for tendonopathies of the achilles and peroneus longus.
- Use ANTT of tibial nerve (ankle DF and EV) for tendonopathies of tiabilias posterior.
What interventions should be used for tendonopathies of the ankle/foot?
PRICE, taping (navicular lift), activity modification to improve healing time, cross friction massage to break adhesions and improve play in muscles (reintroduce healing inflammation in tendonosis). Improve length/joint mobility of talocrural joint DF, subtalor joint INV, rectus femoris, medial hamstrings, psoas, TFL/ITB, and sural nerve (for peroneus longus & achilles tendonopathies) or tibial nerve (for posterior tibialis tendonopathies). Strengthen affected muscles with pain free isometrics and apply PRE's prn, and strengthen hip extensors/ABD/ER.