EpistemisTalalgia
Specialty: Musculoskeletal.
Why it occurs
- Insertional tendinopathy or middle portion of the Achilles tendon
- Retrocalcaneal or subcutaneous Achilles bursitis
- Haglund's deformity (postero-superior bony exostosis of the calcaneus)
- Calcaneal apophysitis (Sever's disease in pediatric patients)
- Plantar fasciitis with inflammatory calcareous insertion
- Baxter's nerve entrapment (first branch of the lateral plantar nerve)
Initial workup
Ultrasound of the Achilles tendon and retrocalcaneal bursa | Ankle x-ray in lateral projection (assesses Haglund's deformity and calcifications) | Magnetic resonance imaging of the ankle if a deep partial tear or calcaneal bone edema is suspected.
red flags
Sharp lancinating pain in the posterior region of the ankle accompanied by an audible clicking sound and sudden loss of plantar flexion of the foot, with a positive Thompson sign (indicates complete rupture of the Achilles tendon).
Standard management
- Naproxen — 500 mg every 12 hours orally; systemic anti-inflammatory
- Diclofenac sodium 1% gel applied topically to the tendon insertion area
- Infiltration of platelet-rich plasma (PRP) guided by ultrasound (avoid infiltration of corticosteroids in the Achilles tendon due to the risk of tendon rupture).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Musculoskeletal
- Listed causes
- 6
- Treatment options
- 3