Sharp intermmitent Tendo Achilles pain

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This middle aged man has 18 months duration of sharp pain at Tendo Achilles insertion. GP thought bursa andsaid to patient it should go away.
What is strange is that it is intermittent lasting about a week and goes away again.
Only seen pt once and will do biomech assessmt next.
Patient can not recall doing anything different in his activities.

So far;
no pain on palpation of TA insertion, no pump bumps.
Tight TA
Forefoot Varus/supinatus
Pronated feet

Question? Why sharp pain and why so spasmodic in symptoms over long time?

 

Does the patient react when applying the TA bursa test? If so it may be relatively quiescent until he wears a specific pair of shoes/boots or, for example, adopts a plantarflexed foot posture for some activities e.g. cycling.

 

Tried deep palpation of bursa with nil response.Neutral STJ position taping of foot helped marginally. Will be suppling premoulded orthotics shortly.

 

TA bursa is normally identifiable by using the end range plantar compression test (Pt in prone), creating a nipping effect of the bursa. Often missed unless applying sufficient compression. Compare effect on other foot.

Colin

 

PS if positive then a steroid injection plus the neutral taping followed by partial weight bearing for 5 days may make the difference. The injection is also good for the differential diagnosis.

Colin