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Hello fellow Pods!

I had an interesting US finding recently for a patient with insertional Achilles tendonopathy symptoms ~6/12 duration.

She is an Aussie rules footy umpire who I suspect was inadquately conditioned prior to a moderate - heavy training regime.

Symptomatic when running
Pain on single leg hop > single leg heel raise
Pain on palpation at lateral Achilles tendon insertion
Local swelling noted and Haglund's bump present (has been rubbing on some shoes with hard heel counter)

Pain has reduced since stopped training approx 3/52

2. R pl fat pad sometimes sore also

3. Proximal calf pain too at times
Tight gastrocs

The US report advised:

Normal Achilles tendon
Thickening and swelling of the paratenon at the clinically painful site (distal / lateral Achilles tendon)
Achilles insertion normal
Bursae, pl fat pad and pl fascia normal

To be honest I have never come across a swollen paratenon (without Achilles involvement), and have not been able to find literature on how to treat it.

I am reviewing her today so will find out how the heel raises and activity modification prescription have faired.

Thank you in advance for your suggestions and input.