Achilles Tendon Contracture
Achilles tendon contracture is a shortening of the Achilles tendon (tendon calcaneus or heel cord), which causes foot pain and strain, with limited ankle dorsiflexion
Causes of achilles tendon contracture
Achilles tendon contracture may reflect a congenital structural anomaly or a muscular reaction to chronic poor posture, especially in women who wear high-heeled shoes and joggers who land on the balls of their feet instead of their heels. Other causes include paralytic conditions of the legs, such as poliomyelitis and cerebral palsy.
Signs and symptoms of achilles tendon contracture
Sharp, spasmodic pain during dorsiflexion of the foot characterizes the reflex type of Achilles tendon contracture. In footdrop (fixed equinus), contracture of the flexor foot muscle prevents placing the heel on the ground.
Physical examination and patient history suggest Achilles tendon contracture. A simple test confirms the condition: While the patient keeps his knee flexed, the examiner places the foot in dorsiflexion; gradual knee extension forces the foot into plantar flexion.
Treatment of achilles tendon contracture
Achilles tendon contracture is treated conservatively by raising the inside heel of the shoe (in the reflex type); gradually lowering the heels of shoes (sudden lowering can aggravate the problem), and stretching exercises, if the cause is high heels; or using support braces or casting to prevent foot drop in a paralyzed patient. Alternative therapy includes using wedged plaster casts or stretching the tendon by manipulation. Analgesics may be given to relieve pain.
With fixed foot drop, treatment may include surgery (tenotomy), although this procedure may weaken the tendon. Tenotomy allows further stretching by cutting the tendon. After surgery, a short leg cast maintains the foot in 90-degree dorsiflexion for 6 weeks. Some surgeons allow partial weight bearing on a walking cast after 2 weeks.
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