Background: This paper presents a case report of physical medicine management of a patient with Achilles tendinopathy.
Case Presentation: A 42 year old female presented with a chief complaint of acute Achilles tendon and gastrocnemius pain on the left side. Her history included successful completion of over 100 half marathon races in the past without intense pain. Current pain prohibits running or non-antalgic walking. The history of intervention included self-care and advice from physical therapists, other runners, interested bloggers, and well-meaning relatives.
Diagnosis and Disposition: Achilles tendinopathy is a common cause of disability. Despite the economic and social relevance of the problem, the causes and mechanisms of Achilles tendinopathy remain unclear. Tendon vascularity, gastrocnemius-soleus dysfunction, age, sex, body weight and height, pes cavus, transverse and longitudinal arch dysfunction, and lateral ankle instability are considered common intrinsic factors. The essence of Achilles tendinopathy is a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in non-collagenous matrix. Tendinopathic tendons have an increased rate of matrix remodeling, leading to a mechanically less stable tendon which is more susceptible to damage. The diagnosis of Achilles tendinopathy is mainly based on a careful history and detailed clinical examination. The latter remains the best diagnostic tool. Over the past few years, various new therapeutic options have been proposed for the management of Achilles tendinopathy. Despite the morbidity associated with Achilles tendinopathy, many of the therapeutic options described and in common use are far from scientifically based. New minimally invasive techniques of subdermal or intramuscular injection of ozone at various concentrations seem to allow faster recovery and accelerated return to sports, rather than open surgery. A genetic component has been implicated in tendinopathies of the Achilles tendon, but these studies are still at their infancy.
Author keywords: Achilles, Tendinopathy, Tendonitis, Ozone, Injection, Neuromusculoskeletal Medicine, Fascia, Therapy, Soft Tissue, Chiropractic, Runner, Chronic Pain
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